Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods

Syed Hashmi, Bhuvaneswari Bibleraaj, William Critchley, Peter Walker, Paul Bishop, Rajamiyer Venkateswaran, James Fildes, Yonan Nizar

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVES The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to decrease saphenectomy-associated wound pain and infection, compared with the traditional open conventional saphenous vein harvesting (OCSVH) technique. Despite all these benefits, the rate of adoption among surgeons has been variable. Criticism of this technique centres on the risk of injury at the time of vein harvest with its potential detrimental effect on structural viability and long-term patency. The aim of our study is to investigate the endothelial preservation of saphenous vein grafts harvested by various extraction methods. METHODS A prospective, observational study of 30 human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin–eosin and CD 31 staining methods. The saphenous vein was harvested endoscopically either by an open tunnel (OT-ESVH), closed tunnel (CT-ESVH) or an OCSVH harvesting technique. Research samples were collected without distension to avoid intraluminal dilatation and endothelial disruption. Both haematoxylin–eosin and immunohistochemistry slides were imaged by a high-resolution slide-scanning system. RESULTS Haematoxylin–eosin staining of the CT-ESVH group showed mostly preserved endothelium (P = 0.398) with some endothelial stretching (P = 1.0) and no endothelial detachment (P = 0.197). The OT-ESVH group showed marked endothelial stretching (P = 0.053). However, the OCSVH group showed significantly more endothelial detachment than the endoscopic groups (P = 0.01). The mean grading score of immunohistochemistry using the CD 31 antibody was much lower in the OT-ESVH group (1.6 ± 0.84, P = 0.009), showing more poorly preserved endothelial cells than the CT-ESVH and OCSVH groups. CONCLUSIONS We observed more endothelial stretching in the OT-ESVH group, which in our opinion, was due to lack of subcutaneous tissue separation, poor visualization and traction stresses across the wall of the saphenous vein. However, the OCSVH method revealed poor endothelial protection with areas of endothelial detachment, not observed with both endoscopic techniques. Interestingly, most preserved endothelium was found in the CT-ESVH group, which was previously known to be associated with worse graft patency.
Original languageEnglish
Pages (from-to)178-185
Number of pages8
JournalInteractive Cardiovascular and Thoracic Surgery
Volume20
Issue number2
Early online date29 Oct 2014
DOIs
Publication statusPublished - 1 Feb 2015

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Saphenous Vein
Transplants
Endothelium
Immunohistochemistry
Staining and Labeling
Subcutaneous Tissue
Traction
Wound Infection

Keywords

  • Endoscopic vein harvesting
  • Human saphenous vein
  • Open conventional vein harvesting

Cite this

Hashmi, Syed ; Bibleraaj, Bhuvaneswari ; Critchley, William ; Walker, Peter ; Bishop, Paul ; Venkateswaran, Rajamiyer ; Fildes, James ; Nizar, Yonan. / Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods. In: Interactive Cardiovascular and Thoracic Surgery. 2015 ; Vol. 20, No. 2. pp. 178-185.
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abstract = "OBJECTIVES The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to decrease saphenectomy-associated wound pain and infection, compared with the traditional open conventional saphenous vein harvesting (OCSVH) technique. Despite all these benefits, the rate of adoption among surgeons has been variable. Criticism of this technique centres on the risk of injury at the time of vein harvest with its potential detrimental effect on structural viability and long-term patency. The aim of our study is to investigate the endothelial preservation of saphenous vein grafts harvested by various extraction methods. METHODS A prospective, observational study of 30 human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin–eosin and CD 31 staining methods. The saphenous vein was harvested endoscopically either by an open tunnel (OT-ESVH), closed tunnel (CT-ESVH) or an OCSVH harvesting technique. Research samples were collected without distension to avoid intraluminal dilatation and endothelial disruption. Both haematoxylin–eosin and immunohistochemistry slides were imaged by a high-resolution slide-scanning system. RESULTS Haematoxylin–eosin staining of the CT-ESVH group showed mostly preserved endothelium (P = 0.398) with some endothelial stretching (P = 1.0) and no endothelial detachment (P = 0.197). The OT-ESVH group showed marked endothelial stretching (P = 0.053). However, the OCSVH group showed significantly more endothelial detachment than the endoscopic groups (P = 0.01). The mean grading score of immunohistochemistry using the CD 31 antibody was much lower in the OT-ESVH group (1.6 ± 0.84, P = 0.009), showing more poorly preserved endothelial cells than the CT-ESVH and OCSVH groups. CONCLUSIONS We observed more endothelial stretching in the OT-ESVH group, which in our opinion, was due to lack of subcutaneous tissue separation, poor visualization and traction stresses across the wall of the saphenous vein. However, the OCSVH method revealed poor endothelial protection with areas of endothelial detachment, not observed with both endoscopic techniques. Interestingly, most preserved endothelium was found in the CT-ESVH group, which was previously known to be associated with worse graft patency.",
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Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods. / Hashmi, Syed; Bibleraaj, Bhuvaneswari; Critchley, William; Walker, Peter; Bishop, Paul; Venkateswaran, Rajamiyer; Fildes, James; Nizar, Yonan.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 20, No. 2, 01.02.2015, p. 178-185.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Histological and immunohistochemical evaluation of human saphenous vein harvested by endoscopic and open conventional methods

AU - Hashmi, Syed

AU - Bibleraaj, Bhuvaneswari

AU - Critchley, William

AU - Walker, Peter

AU - Bishop, Paul

AU - Venkateswaran, Rajamiyer

AU - Fildes, James

AU - Nizar, Yonan

PY - 2015/2/1

Y1 - 2015/2/1

N2 - OBJECTIVES The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to decrease saphenectomy-associated wound pain and infection, compared with the traditional open conventional saphenous vein harvesting (OCSVH) technique. Despite all these benefits, the rate of adoption among surgeons has been variable. Criticism of this technique centres on the risk of injury at the time of vein harvest with its potential detrimental effect on structural viability and long-term patency. The aim of our study is to investigate the endothelial preservation of saphenous vein grafts harvested by various extraction methods. METHODS A prospective, observational study of 30 human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin–eosin and CD 31 staining methods. The saphenous vein was harvested endoscopically either by an open tunnel (OT-ESVH), closed tunnel (CT-ESVH) or an OCSVH harvesting technique. Research samples were collected without distension to avoid intraluminal dilatation and endothelial disruption. Both haematoxylin–eosin and immunohistochemistry slides were imaged by a high-resolution slide-scanning system. RESULTS Haematoxylin–eosin staining of the CT-ESVH group showed mostly preserved endothelium (P = 0.398) with some endothelial stretching (P = 1.0) and no endothelial detachment (P = 0.197). The OT-ESVH group showed marked endothelial stretching (P = 0.053). However, the OCSVH group showed significantly more endothelial detachment than the endoscopic groups (P = 0.01). The mean grading score of immunohistochemistry using the CD 31 antibody was much lower in the OT-ESVH group (1.6 ± 0.84, P = 0.009), showing more poorly preserved endothelial cells than the CT-ESVH and OCSVH groups. CONCLUSIONS We observed more endothelial stretching in the OT-ESVH group, which in our opinion, was due to lack of subcutaneous tissue separation, poor visualization and traction stresses across the wall of the saphenous vein. However, the OCSVH method revealed poor endothelial protection with areas of endothelial detachment, not observed with both endoscopic techniques. Interestingly, most preserved endothelium was found in the CT-ESVH group, which was previously known to be associated with worse graft patency.

AB - OBJECTIVES The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to decrease saphenectomy-associated wound pain and infection, compared with the traditional open conventional saphenous vein harvesting (OCSVH) technique. Despite all these benefits, the rate of adoption among surgeons has been variable. Criticism of this technique centres on the risk of injury at the time of vein harvest with its potential detrimental effect on structural viability and long-term patency. The aim of our study is to investigate the endothelial preservation of saphenous vein grafts harvested by various extraction methods. METHODS A prospective, observational study of 30 human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin–eosin and CD 31 staining methods. The saphenous vein was harvested endoscopically either by an open tunnel (OT-ESVH), closed tunnel (CT-ESVH) or an OCSVH harvesting technique. Research samples were collected without distension to avoid intraluminal dilatation and endothelial disruption. Both haematoxylin–eosin and immunohistochemistry slides were imaged by a high-resolution slide-scanning system. RESULTS Haematoxylin–eosin staining of the CT-ESVH group showed mostly preserved endothelium (P = 0.398) with some endothelial stretching (P = 1.0) and no endothelial detachment (P = 0.197). The OT-ESVH group showed marked endothelial stretching (P = 0.053). However, the OCSVH group showed significantly more endothelial detachment than the endoscopic groups (P = 0.01). The mean grading score of immunohistochemistry using the CD 31 antibody was much lower in the OT-ESVH group (1.6 ± 0.84, P = 0.009), showing more poorly preserved endothelial cells than the CT-ESVH and OCSVH groups. CONCLUSIONS We observed more endothelial stretching in the OT-ESVH group, which in our opinion, was due to lack of subcutaneous tissue separation, poor visualization and traction stresses across the wall of the saphenous vein. However, the OCSVH method revealed poor endothelial protection with areas of endothelial detachment, not observed with both endoscopic techniques. Interestingly, most preserved endothelium was found in the CT-ESVH group, which was previously known to be associated with worse graft patency.

KW - Endoscopic vein harvesting

KW - Human saphenous vein

KW - Open conventional vein harvesting

UR - http://www.mendeley.com/research/histological-immunohistochemical-evaluation-human-saphenous-vein-harvested-endoscopic-open-conventio

U2 - 10.1093/icvts/ivu359

DO - 10.1093/icvts/ivu359

M3 - Article

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EP - 185

JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

IS - 2

ER -