[Endoscopic Long Saphenous Vein Harvest from Femoralsite to Below the Knee through a Single Small Incision for Minimally Invasive Coronary Artery Bypass Grafting].
Masahiro MizumotoTetsuro UchidaSeigo GomiAzumi HamasakiYoshinori KurodaAtsushi YamashitaJun HayashiAi TakahashiDaisuke WatanabeMitsuaki Sadahiro
0
Citation
0
Reference
10
Related Paper
Abstract:
Endoscopic saphenous vein harvest( EVH) for coronary artery bypass grafting( CABG) has been proved to be effective in reduced wound complications without compromising graft patency and mortality. Although EVH was usually performed from femoral site, we performed endoscopic long saphenous vein harvest( ELSH) from femoral to below the knee through a single small incision. There were few reports in EVH from below the knee and ELSH.Between September 2012 and June 2014, 13 patients who underwent ELSH in CABG. We assessed the initial evaluation in ELSH using the VirtuoSaph system. ELSH was performed by our unified procedure protocol to harvest good saphenous vein graft.The success rate of ELSH was 100% (13/13). The harvest time was 83.6±15.2 min, graft length was 52.1±5.6 cm, and number of side branches requiring repair was 2.6±1.6. Beating CABG was performed in all patients. The number of distal anastomoses was 3.8±0.8. Sequential bypass was 12 in total 23 saphenous vein grafts. The early patency was 95% (18/19 grafts) as evaluated by postoperative angiography or coronary enhanced computed tomography. All patients except 1( hospital death)were discharged without major or wound complications.The acceptable results and outcomes were demonstrated by our ELSH procedure protocol. ELSH is considered to be a feasible procedure to harvest enough graft length for 2 CABG and keep the other side of saphenous vein graft intact.Keywords:
Great saphenous vein
Cite
As the type of anastomotic site is considered to be one of the decisive factors for graft-patency in coronary artery bypass grafting(CABG),our aim is to achieve anastomosis forms that potentially promote long-term graft-patency rates. When an arterial graft is used, side-to-side anastomosis is performed, with its incision length being longer than that of the coronary artery, to achieve a cuff-like anastomosis form. When a vein graft is used, on the other hand, it is incised shorter than the coronary artery to achieve a skirt-like anastomosis form instead of a purse-like one. It is thus expected that reliable anastomosis forms can be observed in postoperative angiography.
Cuff
Surgical anastomosis
Cite
Citations (0)
Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG's.
Saphenous vein graft
Derivation
Great saphenous vein
Cite
Citations (2)
Objective To investigate the replantation of complete severed fingertip when vein can't be repaired and only artery be repaired. Methods All 13 cases complete severed fingertips were replantated with only artery anastomosis but vein cannot be repaired.Low molecular weight heparin was applied to prevent blood clotting postoperation. Blood-letting by nail extraction or latero-incision were done in some cases.The survival fingers were observed. Results After 3-12 months followed-up,12 cases survived with satisfactory appearance and locomotion,2-PD of 2-7 mm,but 1 case was failed. Conclusion The replanted fingertip may survival with only artery anastomosis because of fewer tissue and faster recontruction of venous return.It would raise the survival rate of replanted fingertip by blood-letting by nail extraction or latero-incision according to the traumatic condition.
Key words:
Fingertip; Replantation; Microsurgery
Cite
Citations (0)
Extended use of the IMA for routine coronary bypass grafting should do much to reduce the eight- to ten-year failure rate seen so frequently with the saphenous vein graft. However, considerable judgment is necessary for its proper use in a large number of situations and the performance of multiple sequential IMA anastomoses is technically more difficult than with saphenous veins. Special instruments have been devised to improve handling and suturing of the IMA and, as with the saphenous vein graft operation, performance of these anastomoses will be improved with increased experience. Extended use of the IMA is the operation of choice for younger patients with good left ventricular function and offers significant advantages to a group of patients that stands to benefit most by preventing both early and late conduit failure.
Mammary artery
Cite
Citations (5)
Seventy patients underwent sequential coronary artery bypass grafting with saphenous vein during 28 months period. Seventy eight sequential grafts comprising 165 distal anastomoses were performed. Early death was 2.9%. Postoperative angiographic evaluation within 6 months showed 86% patency of the 65 sequential grafts and 89% patency of the 136 distal anastomoses. The patency of anastomosis to left anterior descending artery (LAD), diagonal branch (Dx), obtuse marginal branch (OM), posterior lateral branch (PL), and posterior descending branch (PD) was 87% (13/15), 92% (36/39), 91% (40/44), 81% (26/32) and 100% (6/6), respectively. The patency of Dx-LAD, Dx-OM and OM-PL was 86% (12/14), 94% (15/16) and 76% (13/17), respectively. There was no significant difference in the patency rate according to the site of anastomosis and the inner diameter of the coronary artery. The patency of side to side anastomoses was 92% (65/71) which was not significantly different from that of the end to side anastomoses; 86% (56/65). These results showed sequential aorto-coronary vein grafting means to be effective for the complete coronary artery revascularization .
Derivation
Cite
Citations (1)
Objective To compare the clinical effects of endoscopic and conventional great saphenous vein harvesting in coronary artery bypass grafting.Methods Endoscopic great saphenous vein harvesting was performed in 124 patients undergoing coronary artery bypass grafting(CABG)from Jan.2005 to April 2010.An incision 2cm in length was made on the knee joint and the great saphenous vein was harvested using the Medos system.Clinical data of the 124 patients(EVH Group)were compared with another 110 patients underwent conventional great saphenous vein harvesting for CABG from Jan.2005 to April 2010(Conventional Group)in respect of operating time,complications of the leg,the recovery time to walking,stay in hospital time and cost of operation.Results The operting time in two groups was no significant(273.5±34.7)min vs(279.1±27.9)min.Complications of the leg were significantly less in the EVH Group(12/124)than in the Conventional Group(37/110).The occurrence of pain and numbness of the leg was 16/124 in the EVH Group and 48/110 in the Conventional Group.The occurrence of swelling of the leg was 20/124 in the EVH Group and 57/110 in the Conventional Group.The recovery time to walking was significantly shorter in the EVH Group(2.6±0.2d)than in the ConventionalGroup(3.8±1.3)d.The stay time in hospital was significantly shorter in the EVH Group(10.4±0.7)d than in the Conventional Group(13.3±2.6)d.The cost of operation in EVH group was moer 13 thousand yuan than in conventional group.Conclusion Use of endoscopic vein harvesting in coronary artery bypass grafting decreased the incidence of postoperative leg-wound infections,post-operative pain,and length of hospital stay,but increased the cost of operation.
Great saphenous vein
Cite
Citations (0)
Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 43 distal anastomoses. When calculating patency by number of patent distal anastomoses, this was 46% (median follow-up was 31 months), but calculating by the number of patent grafts we found 52% patency (median follow-up 31 months). In conclusion, we discourage others from using arm veins in aortocoronary bypass operations.
Cephalic vein
Derivation
Cite
Citations (7)
Saphenous vein graft
Great saphenous vein
Cite
Citations (30)
In trying to answer the question about the controversial use of sequential grafts, we determined the mid-term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts.A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 +/- 17.6 months after coronary artery bypass grafting.The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (< 1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%).The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency.
Coronary arteries
Derivation
Cite
Citations (28)
Visually distinguishing artery from vein during coronary artery bypass grafting (CABG) can be occasionally challenging and may result in errors in anastomosis. We report an unusual case of onpump CABG surgery in which the left internal mammary artery (LIMA) was anastomosed to an epicardial vein instead of the left anterior descending (LAD) coronary artery erroneously (Iranian Heart Journal 2009; 10 (2):31-33).
Great cardiac vein
Cite
Citations (0)