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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Morphologic changes of the saphenous vein Y-composite graft based on the left internal thoracic artery: 1-year
Ho Young Hwang1, Bon-Kwon Koo2, Se Jin Oh3
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Objective:
We evaluated vessel wall characteristics and changes in the lumen diameter (LD) of saphenous vein (SV) conduits harvested with minimal manipulation and used as Y-composite grafts based on the in situ left internal thoracic artery (ITA) 1 year after coronary revascularization.
Methods:
Twenty-eight patients who underwent off-pump coronary revascularization using minimally manipulated SV Y-composite grafts were studied. Quantitative angiography was performed early and 1 year postoperatively to evaluate changes in the conduits. An intravascular ultrasound study of the proximal left ITA and SV conduits was also performed after 1-year postoperative angiography.
Results:
The mean LD of the SV conduit decreased during the first year postoperatively (3.58 ± 0.61 mm to 2.71 ± 0.42 mm; P < .001). The mean LD of the proximal left ITA increased (2.41 ± 0.25 mm to 2.63 ± 0.30 mm; P < .001), but was unchanged in the distal left ITA conduits. An intravascular ultrasound study demonstrated that the intima-media (IM) thickness and the proportion of IM to vessel area were 0.31 ± 0.12 mm and 29.1% ± 8.3% in the SV, and 0.23 ± 0.08 mm and 25.1% ± 8.6% in the proximal left ITA, respectively. Absolute and percentage decreases in SV diameter were greater in SV grafts with a larger diameter initially and with single distal anastomosis than those without. However, those decreases did not result in an increased proportion of IM to vessel area.
Conclusions:
Saphenous vein conduits harvested with minimal manipulation and used as Y-composite grafts based on the left ITA revealed decreased LD without accompanying abnormal IM thickening based on the flow requirements at 1 year postoperatively.
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