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The saphenous vein (SV), a blood vessel superficially located in the leg, is the most commonly used graft in patients requiring coronary artery bypass surgery (CABG). Using conventional surgical methods of preparing the SV this vessel is subjected to considerable trauma that influences graft performance. While much interest has focussed on reducing damage to the veins’ innermost surface (the endothelium) during CABG, preservation of its outer layer (the adventitia) has been largely neglected. Within the adventitia are located the vascular nerves and vasa vasorum, a microvascular network providing the vessel wall with oxygen and nutrients. An atraumatic, no-touch, technique of harvesting the SV has been introduced that dramatically improves the performance of this vessel when used in patients undergoing CABG. When preparing the SV by the no-touch technique the vessel is removed complete with its cushion of surrounding tissue and in doing so the vein’s normal architecture is maintained and the adventitia remains intact. There is evidence that the improved patency of no-touch grafts is associated with preservation of structures in the SV adventitia. In this mini review we discuss the preparation of vessels used as bypass grafts in patients with heart disease, the use of synthetic and tissue-engineered graft materials and the potential importance of retaining or mimicking normal vessel structure.
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Author(s): Michael R Dashwood and Andrzej Loesch
Adventitia, bypass graft, saphenous vein, vasa vasorum, vascular nerves