[HSF] AATS

[gustavo abuin]

If we harvest a saphenous vein  like a mammary artery and we select a 
segment of vein without any valve and anastomose it  to the LAD, we will 
very surprised about its patency.
I don`t dilate the right mammary artery after cut it to anastomose with the 
left.
So.
Why do I let my assistance dilate "gently" any piece of saphenous vein ?
Why do I dilate ""gently""(?) any piece of saphenous vein?
Why do I directly "imagine" that a saphenous vein is a delicate graft to be 
treated in a similar fashion like the right mammary free graft?
 I will treat veins like a delicate and unique conduit from next monday.
I will send you the results on 2018 (maybe)
 gustavo.

----- Original Message ----- 
From: "Michael Firstenberg" <msfirst at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Saturday, May 17, 2008 10:58 PM
Subject: Re: [HSF] AATS


>I am sure that the brutal way in which tissue is handled - be it vein,
> radial, or even IMA can have a huge potential impact on long term 
> patencies
> - against something probably impossible to prove but something that makes
> sense.  We must continue to search for why veins dont work as well as IMAs
> (I in fact have an active research project in this area, but can not get
> funding - hmmmm why?  probably no expensive disposable or lifelong
> medications involved).  But if we put a vein to a crappy diffusely 
> diseases
> target - then of course it will go down.  May be part of it is that we are
> bypass sicker and sicker patients with crappier and crappier targets.  As 
> I
> am sure our international colleagues can attest to CAD is different in
> different part of the world and to categorically compare the results in 
> one
> society to another may be a little misleading.
>
> -michael
>
> On Sat, May 17, 2008 at 6:24 PM, <Hgrmd at aol.com> wrote:
>
>> 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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>> family
>> favorites at AOL Food.
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