Sivakumar Krishnasamy, Raja Amin Raja Mokhtar, Ahmad Farouk Musa, Xian Pei Cheong, Toh Yen Fa
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Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.</p><p><strong>Methods: </strong>Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO<sub>2</sub> (carbon dioxide) ESVH, open CO<sub>2</sub> ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.</p><p><strong>Results: </strong>Open CO<sub>2</sub> ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO<sub>2</sub> ESVH group (33.25% ± 28.71, <i>P</i> < <i>0.0003</i>). This represents a more poorly preserved endothelial cells in the Open CO<sub>2</sub> ESVH than the closed CO<sub>2</sub> ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, <i>p</i> = <i>0.004</i>). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH.</p><p><strong>Conclusion: </strong>We observed more endothelial detachment in the open CO<sub>2</sub> ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. 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引用次数: 0
摘要
背景：据报道，与开放式大隐静脉采集（OSVH）技术相比，内窥镜大隐静脉采集（ESVH）可减少伤口疼痛和感染。但关于这项技术仍存在争议。我们的研究旨在调查通过不同技术采集的隐静脉（SV）移植物的内皮保存情况。我们还进一步观察了采集和闭合时间、切口长度以及静脉压力扩张对静脉内皮的影响：方法：对 60 例人体大隐静脉移植物进行前瞻性观察研究，通过血红素-伊红和分化簇 31（CD 31）染色评估内皮的保存情况。通过闭合式二氧化碳ESVH、开放式二氧化碳ESVH或OSVH采集技术在内窥镜下采集隐静脉。收集人口统计学数据和术中数据。为比较静脉扩张前后的差异，从每位患者身上采集了两份隐静脉样本。通过高分辨率玻片扫描系统对血红素-伊红和免疫组化玻片进行成像：结果：开放 CO2 ESVH 组的内皮脱落数量最多。使用 CD31 抗体的免疫组化法的平均评分在开放式 CO2 ESVH 组要低得多（33.25% ± 28.71，P 0.0003）。这表明开放式 CO2 ESVH 比闭合式 CO2 ESVH 的内皮细胞保存更差。与 OSVH 组相比，ESVH 两组的闭合时间和切口长度都明显较短。膨胀静脉样本的免疫组化得分明显偏低（39.0% ± 30.08，P = 0.004）。随机样本 B 中的 OSVH（代表将使用的导管）与 ESVH 相比，内皮保存更好，内皮脱落更少：我们在开放式二氧化碳 ESVH 组观察到更多的内皮脱落，这是由于皮下组织分离不足、可视性差以及大隐静脉壁上的牵引应力造成的。闭合式二氧化碳 ESVH 组保留了更多的内皮细胞，但 OSVH 组的情况最好，内皮细胞脱落最少，CD31 抗体得分更高：在线版本包含补充材料，可在 10.1007/s12055-024-01752-3上查阅。
A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting.
Background: The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium.
Methods: Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system.
Results: Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH.
Conclusion: We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01752-3.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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