ABSTRACT
No-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasa vasorum is implicated in the success of NT harvesting. We compared the vasa vasorum and endothelial nitric oxide synthase (eNOS) in NT SV with ITA and radial artery (RA) grafts. Skeletonized SV (SSV) was also analyzed. The NT SV had a higher number and larger vasa vasorum compared with ITA (P = .0001) and RA (P = .0004) that correlated with eNOS protein. Activity of eNOS in SSV grafts was significantly lower than NT SV grafts (P = 004). Since a high proportion of the vasa vasorum are removed in SSV using the CT, we suggest that preservation of the vasa vasorum and eNOS-derived NO contributes to the high patency for NT as compared with SSV grafts.
Subject(s)
Coronary Artery Bypass , Mammary Arteries/enzymology , Nitric Oxide Synthase Type III/metabolism , Radial Artery/enzymology , Saphenous Vein/enzymology , Tissue and Organ Harvesting/methods , Vasa Vasorum/enzymology , Aged , Blotting, Western , Coronary Artery Bypass/adverse effects , Graft Occlusion, Vascular/enzymology , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Immunohistochemistry , Male , Mammary Arteries/physiopathology , Mammary Arteries/transplantation , Middle Aged , Nitric Oxide/metabolism , Radial Artery/physiopathology , Radial Artery/transplantation , Randomized Controlled Trials as Topic , Saphenous Vein/physiopathology , Saphenous Vein/transplantation , Tissue and Organ Harvesting/adverse effects , Vasa Vasorum/physiopathology , Vasa Vasorum/transplantation , Vascular PatencyABSTRACT
Autologous saphenous vein is the most commonly used conduit for coronary artery bypass surgery with more than 50% grafts occluding within 10 years. In conventional preparation the vein undergoes considerable surgical trauma with damage to the outer layers during harvesting. Within these regions are situated the vasa vasorum and small vessels providing oxygen and nutrients to the vessel wall. Certain vasa vasorum terminate in the vessel lumen where it is suggested that they have a physiological role. Preservation of the vasa vasorum of saphenous veins used as bypass conduits may play an important role in the maintenance of graft patency.
