RESUMO
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.
Assuntos
Ponte de Artéria Coronária , Artéria Torácica Interna/enzimologia , Óxido Nítrico Sintase Tipo III/metabolismo , Artéria Radial/enzimologia , Veia Safena/enzimologia , Coleta de Tecidos e Órgãos/métodos , Vasa Vasorum/enzimologia , Idoso , Western Blotting , Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/enzimologia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Imuno-Histoquímica , Masculino , Artéria Torácica Interna/fisiopatologia , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Artéria Radial/fisiopatologia , Artéria Radial/transplante , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena/fisiopatologia , Veia Safena/transplante , Coleta de Tecidos e Órgãos/efeitos adversos , Vasa Vasorum/fisiopatologia , Vasa Vasorum/transplante , Grau de Desobstrução VascularRESUMO
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.