[HSF] AATS

[Prasanna Simha M]

There are studies showing that harvesting the veins with surrounding fascia
and fat results in a very high patency comparable to arteries. Maybe that is
worth considering rather than aesthetic clearing of veins.

On Sun, May 18, 2008 at 6:29 PM, gustavo abuin <gabuin at intramed.net> wrote:

> 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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>>> favorites at AOL Food.
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-- 
Prasanna Simha M