Sen Onur, Gonca Suheyla, Solakoglu Seyhun, Dalcik Hakki, Dalcik Cannur, Ozkara Ahmet
Department of Cardiovascular Surgery, Istanbul Bilim University School of Medicine, Istanbul.
Heart Surg Forum. 2013 Aug 1;16(4):E177-83. doi: 10.1532/HSF98.20131006.
Optimization of saphenous vein patency for myocardial revascularization.
The goal of this study was to present the no-touch technique of saphenous vein preparation. This technique consists of harvesting the vein with a pedicle of surrounding tissue, which protects the vein from distension pressure.
We performed a prospective, randomized study that compared 2 techniques for harvesting saphenous vein-conventional and no-touchin 40 patients undergoing coronary artery bypass grafting. We carried out a morphologic study of the endothelium with the aid of light and transmission electron microscopy and an immunohistochemical assessment to identify adenosine, inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor (VEGF) in the vein wall.
The integrity of endothelial cell and all vascular layers was maintained better with the no-touch technique than with the conventional procedure. The immunohistochemical assessment revealed that adenosine receptor, iNOS, and VEGF immunoexpression levels were normal or lower in the no-touch group than in the conventional-harvest group, as shown by the staining densities in all layers of the vein wall.
Endothelial integrity and adenosine, iNOS, and VEGF immunoreactivities were better preserved when the no-touch technique was used for vein graft harvesting. The mechanical protection provided by the cushion of surrounding tissue in the no-touch group and the vasorelaxation and thromboresistant activities of nitric oxide may be responsible for the reduction in vasospasms and the improved patency rate.
优化用于心肌血运重建的大隐静脉通畅率。
本研究的目的是介绍大隐静脉制备的非接触技术。该技术包括采集带有周围组织蒂的静脉，这可保护静脉免受扩张压力。
我们进行了一项前瞻性随机研究，比较了40例行冠状动脉旁路移植术患者的两种大隐静脉采集技术——传统技术和非接触技术。我们借助光镜和透射电子显微镜对内皮进行了形态学研究，并进行了免疫组织化学评估，以鉴定静脉壁中的腺苷、诱导型一氧化氮合酶（iNOS）和血管内皮生长因子（VEGF）。
与传统方法相比，非接触技术能更好地维持内皮细胞和所有血管层的完整性。免疫组织化学评估显示，非接触组的腺苷受体、iNOS和VEGF免疫表达水平正常或低于传统采集组，如静脉壁各层的染色密度所示。
采用非接触技术采集静脉移植物时，内皮完整性以及腺苷、iNOS和VEGF的免疫反应性得到了更好的保留。非接触组中周围组织垫提供的机械保护以及一氧化氮的血管舒张和抗血栓形成活性可能是血管痉挛减少和通畅率提高的原因。
