Influence of Three Different Surgical Techniques on Microscopic Damage of Saphenous Vein Grafts—A Randomized Study

Author:

Zivkovic Igor12,Krasic Stasa3,Stankovic Milica4,Milacic Petar12,Milutinovic Aleksandar1,Zdravkovic Djordje1,Tabakovic Zoran1ORCID,Peric Miodrag12,Krstic Miljan45ORCID,Bojic Milovan12,Milic Dragan56,Micovic Slobodan12

Affiliation:

1. Cardiac Surgery Department, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia

2. School of Medicine, University of Belgrade, 11000 Belgrade, Serbia

3. Cardiology Department, Mother and Child Health Care Institute, 11000 Belgrade, Serbia

4. Center for Pathology and Pathological Anatomy, Clinical Center of Niš, 18000 Niš, Serbia

5. Faculty of Medicine, University of Niš, 18000 Niš, Serbia

6. Cardiac Surgery Department, Clinical Center of Niš, 18000 Niš, Serbia

Abstract

Background and Objectives: The saphenous vein is one of the most common used grafts (SVG) for surgical revascularization. The mechanism of the SVGs occlusion is still unknown. Surgical preparation techniques have an important role in the early and late graft occlusion. Our study analyzed the influence of the three different surgical techniques on the histological and immunohistochemical characteristics of the vein grafts. Methods: Between June 2019 and December 2020, 83 patients who underwent surgical revascularization were prospectively randomly assigned to one of the three groups, according to saphenous vein graft harvesting (conventional (CVH), no-touch (NT) and endoscopic (EVH)) technique. The vein graft samples were sent on the histological (hematoxylin-eosin staining) and immunohistochemical (CD31, Factor VIII, Caveolin and eNOS) examinations. Results: The CVH, NT, and EVH groups included 27 patients (mean age 67.66 ± 5.6), 31 patients (mean age 66.5 ± 7.4) and 25 patients (mean age 66 ± 5.5), respectively. Hematoxylin-eosin staining revealed a lower grade of microstructural vein damage in the NT group (2, IQR 1-2) in comparison with CVH and EVH (3, IQR 2-4), (4, IQR 2-4) respectively (p < 0.001). Immunohistochemical examination revealed a high grade of staining in the NT group compared to the CVH and EVH group (CD 31 antibody p = 0.02, FVIII, p < 0.001, Caveolin, p = 0.001, and eNOS, p = 0.003). Conclusion: The best preservation of the structural vein integrity was in the NT group, while the lowest rate of leg wound complication was in the EVH group. These facts increase the interest in developing and implementing the endoscopic no-touch technique.

Publisher

MDPI AG

Subject

General Medicine

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