How to Shorten, Lengthen, or Untwist Saphenous Vein Grafts
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Saphenous veins
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Saphenous vein grafts (SVGs) sometimes occur as vein graft stenosis or failure in coronary artery bypass grafting. The purpose of this study was to detect the factors affecting vein graft atherosclerosis.
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Journal Article Early rupture of a saphenous vein graft Get access European Journal of Cardio-Thoracic Surgery, Volume 5, Issue 12, December 1991, Pages 663–664, https://doi.org/10.1016/1010-7940(91)90125-4 Published: 01 December 1991
Mediastinitis
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In four redo CABG patients, new saphenous vein grafts were anastomosed to the angiographically normal part of the old, and partially narrowed or occluded saphenous vein grafts in an end-to-side fashion. Inner surface of the old saphenous vein was confirmed to be smooth and free of atherosclerotic change during anastomosis. Postoperative course was uneventful and angiography demonstrated the good patency of new saphenous vein grafts in all patients. Although this technique is not acceptable if the old saphenous vein graft shows extensive atherosclerotic change, this method may be a useful alternative in case of limited saphenous vein graft disease in terms of less difficulty and operation time.
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Objective To summarize the early clinical results of application of endoscopic saphenous vein harvesting(EVH)in coronary artery bypass grafting.Methods From January 2010 to December 2010,84 consecutive patients underwent coronary artery bypass grafting(CABG),EVH in 36 cases and the multiple interrupted incisions in 48 cases.Results There was no significantly different saphenous vein in the length between the two groups(P 0.05).But,EVH group had longer harvesting time,shorter incisions length and less suture time than the other group(all P 0.05).Within 1 month after surgery,EVH group presented significantly lower wound-related complication rate than the multiple interrupted incisions group 13.9%(5/36) vs.37.5%(18/48)(P 0.05).Conclusion EVH is a safe and recommended alternative technique for harvesting saphenous vein in coronary artery bypass grafting.
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Objective To construct the SD rat model of saphenous vein grafts restenosis after coronary artery bypass grafting. Methods Seventy-five male SD rats were undergone the vein-to-artery interposition,and commonly bred after operation.The specimen were detected at days 1,3,7,14 and 28 after operation,and tissue sections were observed by HE staining. Results Neointimal thickening was greater at the proximal and,to a lesser extent,distal ends,in comparison to the middle of the graft.There was hyperplasia in different degree.Interposition of vein-to-artery showed survival of vein graft endothelial cells.Conclusion The vein-to-artery interposition model is successfully established,and could be an ideal model for further preventing vein graft intimal hyperplasia after bypass grafting.
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Objective: To compare the patency rate of saphenous vein bypass graft by endoscopic vein harvesting(EVH) and traditional open vein harvesting(OVH) in coronary artery bypass grafting(CABG). Methods: 380 coronary heart disease(CHD) cases underwent CABG in our hospital from February 2012 to February 2013 were admitted and divided into EVH group(n=178) and OVH group(n=202) according to the different ways of harvesting great saphenous vein. Coronary artery CT was applied one year after the surgery to observe the patency of saphenous vein bypass graft. Results: No intraoperative adverse events occurred. A total of 376 vein grafts were completed in EVH group. 19 cases lost follow-up and coronary artery CT examination one year after the surgery showed that 21 out of remained 333 grafts occurred vascular restenosis. 458 vein grafts were completed in OVH group. 11 cases lost follow-up and coronary artery CT examination one year after the surgery showed that 26 out of remained 427 grafts occurred vascular restenosis.Statistical analysis demonstrated that no significant differences existed between the two groups(P 0.05). Conclusion: No obvious statistical differences existed in saphenous vein bypass graft patency rate by endoscopic vein harvesting and traditional open vein harvesting in coronary artery bypass grafting.
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Sequential coronary artery grafting is a common procedure. Holding the graft in the correct alignment and orientation in a limited pericardial space and taking a suture at the correct place on the graft is difficult. Graft slippage from the assistant can be distracting to the surgeon, unnecessarily increasing the anastomosis time and also affecting graft patency due to improperly placed sutures. We describe a simple device (Sharma's clamp) for graft holding and stabilization for sequential bypass grafting in coronary artery bypass surgery.
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