Endoscopic Versus Conventional Vein Harvest Technique: Histological and Immunohistochemical Evaluation of Venous Wall Integrity
Keywords:saphenous vein, endoscopic, endothelial, harvest
Background: The introduction of endoscopic saphenous vein graft harvesting has been known for two decades. It offers benefits related to decreased rate of donner site complications. Debates related to its safety in terms of trauma to the wall of the venous graft and long-term graft patency have been raised, but few studies had investigated this point. Our aim is to compare the endoscopic saphenous vein harvest and conventional harvest techniques, in terms of the integrity of the wall of the vein graft.
Methods: A prospective study in which we examined 80 samples of saphenous vein from 80 patients to whom coronary artery bypass grafting was done. Patients randomly were assigned to either technique. Vein samples were taken from patients having the conventional technique (group 1, 40 patients) and from patients having endoscopic vein harvest (group 2, 40 patients). Vein samples were stained with Hematoxylin & Eosin, Masson’s trichrome, and immunohistochemical stain for CD 31 and then examined by light microscopy. The degree of intimal staining was graded from 0% to 100%, which is directly related to the degree of intimal preservation (the least injury, the more the staining score) and vein media changes were reported.
Results: Patient characteristics were comparable in the groups. Group 1 (conventional group) was better than group 2 (endoscopic group), regarding endothelial integrity and medial changes although it was statistically not significant.
Conclusion: Both the conventional and endoscopic techniques are comparable, regarding the intimal preservation of the venous graft.
Allen KB, Griffith GL, Heimansohn DA, et al. 1998. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. The Annals of thoracic surgery. 66(1), 26-31.
Bonde P, Graham AN, MacGowan SW. 2004. Endoscopic vein harvest: advantages and limitations. The Annals of thoracic surgery. 77(6), 2076-2082.
Brown EN, Kon ZN, Tran R, et al. 2007. Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins. The Journal of thoracic and cardiovascular surgery. 134(5), 1259-1265.
Cable DG, Dearani JA, Pfeifer EA, Daly RC, Schaff HV. 1998. Minimally invasive saphenous vein harvesting: endothelial integrity and early clinical results. The Annals of thoracic surgery. 66(1), 139-143.
Ferdinand FD, MacDonald JK, Balkhy HH, et al. 2017. Endoscopic conduit harvest in coronary artery bypass grafting surgery: an ISMICS systematic review and consensus conference statements. Innovations. 12(5), 301-319.
Hashmi SF, Krishnamoorthy B, Critchley WR, et al. 2015. Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods. Interactive cardiovascular and thoracic surgery. 20(2), 178-185.
Jacobs JP, Shahian DM, D’Agostino RS, et al. 2017. The Society of Thoracic Surgeons national database 2017 annual report. The Annals of Thoracic Surgery. 104(6), 1774-1781.
Khaleel MS, Dorheim TA, Duryee MJ, et al. 2012. High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure. The Annals of thoracic surgery. 93(2), 552-558.
Kiaii B, Moon BC, Massel D, et al. 2002. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. The Journal of Thoracic and Cardiovascular Surgery. 123(2), 204-212.
Kiani S, Desai PH, Thirumvalavan N, et al. 2012. Endoscopic venous harvesting by inexperienced operators compromises venous graft remodeling. The Annals of thoracic surgery. 93(1), 11-18.
Kodia K, Patel S, Weber MP, et al. 2018. Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis. Annals of cardiothoracic surgery. 7(5), 586.
Krishnamoorthy B, Critchley WR, Thompson AJ, et al. 2017. Study comparing vein integrity and clinical outcomes in open vein harvesting and 2 types of endoscopic vein harvesting for coronary artery bypass grafting: the VICO randomized clinical trial (vein integrity and clinical outcomes). Circulation. 136(18), 1688-1702.
Lawrie GM, Weilbacher DE, Henry PD. 1990. Endothelium-dependent relaxation in human saphenous vein grafts: effects of preparation and clinicopathologic correlations. The Journal of Thoracic and Cardiovascular Surgery. 100(4), 612-620.
Meyer DM, Rogers TE, Jessen ME, Estrera AS, Chin AK. 2000. Histologic evidence of the safety of endoscopic saphenous vein graft preparation. The Annals of thoracic surgery. 70(2), 487-491.
Nasso G, Anselmi A, De Filippo CM, et al. 2007. Evaluation of less invasive method for saphenous vein harvest in patients with type II diabetes. Journal of Cardiovascular Medicine. 8(7), 511-516.
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2019. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal. 40(2), 87-165.
Olsen MA, Sundt TM, Lawton JS, et al. 2003. Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery. The Journal of Thoracic and Cardiovascular Surgery. 126(4), 992-999.
Rubens FD, Labow RS, Meek E, Bedard E. 1998. Papaverine solutions cause loss of viability of endothelial cells. Journal of Cardiovascular Surgery. 39(2), 193.
Rousou LJ, Taylor KB, Lu XG, et al. 2009. Saphenous vein conduits harvested by endoscopic technique exhibit structural and functional damage. The Annals of thoracic surgery. 87(1), 62-70.
Saito T, Kurazumi H, Suzuki R, Matsuno Y, Mikamo A, Hamano K. 2020. Preserving the endothelium in saphenous vein graft with both conventional and no-touch preparation. Journal of Cardiothoracic Surgery. 15(1), 1-6.
Samano N, Dashwood M, Souza D. 2018. No-touch vein grafts and the destiny of venous revascularization in coronary artery bypass grafting—a 25th anniversary perspective. Annals of cardiothoracic surgery. 7(5), 681.
Zenati MA, Bhatt DL, Bakaeen FG, et al. 2019. Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass. New England Journal of Medicine. 380(2), 132-141.