[HSF] AATS

[Hgrmd at aol.com]

Ani,
  For such an analytical fellow, I'm surprised at the conclusions  you've 
drawn about endoscopically harvested veins.  As far as I know,  there's never 
been a head to head study comparing open versus closed harvesting  of the veins 
in regards to patency.  I have the clinical experience of  having done CABG's 
for at least 10 to 12 years of open veins and around 6-8  years of endoveins.  
I certainly haven't perceived a difference in  patency.  In other words, I 
can't tell that a lot more cases are coming to  cath with closed grafts as 
compared to open harvested veins.  Indeed, there  may be a difference, but it has 
been imperceptible to us.  
  Our P.A.'s are extremely skilled at rapidly delivering an endoscopic  vein 
through a 2 cm stab wound (usually no incision in groin at all) that rarely  
has avulsed branches requiring repair with 7-0.  Quite frankly, I can't  tell 
the difference in appearance between open and closed harvested veins.   Your 
point about dilating with blood and papaverine is well taken.  That  preparation 
may be less stressful to the vein's endothelium.  However, in  the end, no 
matter how you prep them, the veins die no matter what you do to  them.  That's 
why it is imperative that we spend more time harvesting  arterial conduits and 
not letting concerns about time supervene.
 
Hal



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