[HSF] AATS

Ben Bidstrup benjamin.bidstrup at bigpond.com
Mon May 19 08:03:21 EDT 2008 

Which is more  important - a satisfactory i.e. perfect vein or the 
annoyance of a slow healing leg wound. To the patient it is easy - 
most hate the leg wounds even if they heal well. But it is rather 
like the story of stents do they really care about long term results? 
I doubt it. Could be the basis for a good study.



>t's not just esthetics when doing endoveins.  The wound complication 
>rate is a fraction of the open technique.  Particularly evident in 
>fat diabetics.
>
>Hal
>Sent from my Verizon Wireless BlackBerry
>
>-----Original Message-----
>From: "Prasanna Simha M" <prasannasimha at gmail.com>
>
>Date: Sun, 18 May 2008 18:56:08
>To:OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] AATS
>
>
>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
>>>>
>>>>
>>>>
>>>>  **************Wondering what's for Dinner Tonight? Get new twists on
>>>>  family
>>>>  favorites at AOL Food.
>>>>  (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)
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>
>
>
>--
>Prasanna Simha M
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon

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