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. 2018 Dec;34(Suppl 3):251-257.
doi: 10.1007/s12055-018-0753-9. Epub 2018 Oct 29.

Saphenous vein: advances

Ki-Bong Kim  1 , Ho Young Hwang  1 , Domingos Savio Ramos de Souza  2 , David Paul Taggart  3
Affiliations

Saphenous vein: advances

Ki-Bong Kim et al. Indian J Thorac Cardiovasc Surg. 2018 Dec.

Abstract

Although the saphenous vein (SV) is a widely used conduit for coronary artery bypass graft surgery (CABG), lower long-term graft patency rates and worse clinical outcomes have been reported after CABG performed with SV grafts compared with CABG performed with internal thoracic artery (ITA) grafts. Of various efforts to overcome the limitations of SV that are resulting from structural and functional differences from arterial conduit, recent improvement in harvesting techniques including no-touch technique, surgical strategy of using the SV as part of a composite graft over an aortocoronary bypass graft, and external stenting of the SV will be discussed in this topic.

Keywords: Composite graft; Coronary artery bypass graft surgery; Saphenous vein.

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Conflict of interest statement

Conflict of interestProf. David Taggart states that he has received research funding, speaking, and traveling honoraria from Vascular Graft Solutions (VGS), and also has share options in VGS. Ki-Bong Kim, Ho Young Hwang, and Domingos Souza state that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A “no-touch” saphenous vein in situ after harvesting and without spasm
Fig. 2
Fig. 2
10-year old postmortem specimens of conventional vein graft (CVG) and “no-touch” vein graft (NTVG)
Fig. 3
Fig. 3
Excessive long no-touch saphenous vein graft (arrow) without kinking
Fig. 4
Fig. 4
Luminal endothelium of the saphenous vein in the a normal control, b conventional harvest, and c minimally manipulated composite grafting groups. CD34 was stained as a brown color (a: × 200; b, c: × 100). Note the defects in staining (black arrows), particularly in the conventional harvest group. Endothelial nitric oxide synthase staining also showed defects in staining (black arrows), particularly in the e conventional harvest group compared to the d normal control and f minimally manipulated composite groups (× 100) (reprinted from [21] with permission from Elsevier)
Fig. 5
Fig. 5
Angiographic findings of the saphenous vein (SV) composite grafts based on the left internal thoracic artery (LITA) at a, b 1 day and c, d 1 year after coronary artery bypass graft surgery. The graft diameter of the SV became smaller and flow rate increased. p-LITA, Proximal LITA; d-LITA, distal LITA; OM, obtuse marginal coronary artery; LAD, left anterior descending coronary artery; PDA, posterior descending coronary artery (reprinted from [29] with permission from Elsevier)
Fig. 6
Fig. 6
Images of intravascular ultrasound of the proximal left internal thoracic artery (LITA) and saphenous vein (SV). The lumen of the proximal LITA (p-LITA) and SV showed a thin intima-media without any abnormal plaque (reprinted from [29] with permission from Elsevier)
Fig. 7
Fig. 7
Angiographic findings of the saphenous veins (SVs) at 4.5 years after surgery. a Unsupported SV to the first obtuse marginal artery and b VEST supported SV to the second obtuse marginal artery in the same patient
See this image and copyright information in PMC

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