Modern methods of preparing autologous vein for bypass surgery (non-systematic review)

Abstract

INTRODUCTION: The use of an autologous vein conduit in bypass operations is the leading trend in vascular and cardiac surgery. In the context of a high risk of repeated interventions and of limited availability of high-quality venous resources, it is important that the autovenous conduit remain functional as long as possible.

AIM: To study the dynamics of conclusions from the modern research works on harvesting, preservation and quality assessment of autovein grafts in the postoperative period.

The graft patency after open and endoscopic harvesting is comparable. Unsatisfactory results in terms of the long-term patency of an endoscopically harvested autovein may be associated with a long period of training in endoscopic techniques. They facilitate fast healing of postoperative wounds on the leg and reduce pain syndrome. The no touch open harvest technique, the use of low pressure when distending an autovenous graft, and ligation of the tributaries are factors that reduce the risk of postoperative hyperplasia of intima, thus contributing to a long-term functioning of the shunt and reducing the number of reinterventions. The preferable method of harvesting an autovenous graft for bypass surgeries in the lower limbs is an open bridging method. Keeping the autovenous graft in the whole autologous blood before the bypass surgery is also believed to reduce the risk of autograft injury, but randomized studies with a greater number of observations are required. Control of the graft quality before and after application of anastomosis and initiation of blood flow helps to improve the immediate and long-term bypass patency, and is performed using ultrasound imaging, measurement of blood flow transit time, angiographic examination, introduction of indocyanine green, and thermal imaging.

CONCLUSION: This review presents a modern multicomponent analysis of the role of mechanical, thermal, environmental and organic factors in the formation of the properties of an autovein conduit, essential for maintaining its maximal patency as of an arterial bypass, and the methods of intraoperative patency control.

Keywords

endoscopic vein harvesting / no touch technique / bridging technique / hydraulic distension / graft preservation / femoropopliteal bypass / coronary artery bypass grafting

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