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eComment: Surgical technique can prevent saphenous vein wall damageduring coronary artery bypass graft surgery

Cardiothoracic Surgery Department, Euromedica – Geniki Kliniki, Paraliaki Ave, Thessaloniki, Greece

A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presenting as a left lung mass

We read with great interest the article from Abbasi et al. [1] concerning a large saphenous vein graft aneurysm (SVGA) one year after coronary artery bypass grafting (CABG) surgery and we would like to congratulate them for their successful result. Even though reoperative coronary bypass surgery is very frequent today, we do not see a lot of venous aneurysms from previous grafts. However, it has to be highlighted that most lesions of this kind, especially early after surgery, could be originating from injury to the vein during harvesting.

SVGA is defined as a localized dilation of the vessel to 1.5 times the expected normal diameter. These are classified as true and false aneurysms (or pseudoaneurysms): true aneurysms involve all three layers of the vessel wall, whereas false aneurysms involve disruption of one or more layers of the vessel wall with a well-defined collection of blood or hematoma outside the endothelium [2]. Further classification of SVGAs as large or small is not well defined, although dilation to more than 2 cm has generally led to consideration for surgical therapy [2].

The initial event in SVGA formation is thought to be atheroma formation followed by plaque rupture, resulting in injury to the vessel wall, which is exacerbated by arterial pressures within the vein graft. Valve insertion points along the vein graft are especially prone to true SVGA formation, where smooth muscle in the media changes from circular to a weaker longitudinal orientation. Other possible contributing factors include varicosities with impaired elastic tissue integrity not detected at the time of harvesting, vascular injury from previous percutaneous intervention (PCI) and surgical trauma [3].

The most important point is the continuing improvement of surgical techniques to prevent vein wall damage during harvesting and implantation and this may contribute to a higher graft patency rate in follow-up. There is evidence that harvesting the saphenous vein together with a pedicle of surrounding tissue protects the vein from spasm, thereby obviating the need for vein distension [4]. The cushion of surrounding tissue also allows for careful handling of the vein. There is also enough evidence that the endothelial integrity is much better preserved in veins harvested by the ‘no touch’ technique than in veins harvested by the conventional technique [5].

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1. Abbasi M, Soltani G, Shomali A, Javan H. A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presentingas a left lung mass. Interact CardioVasc Thorac Surg 2009;8:691–693.[Abstract/Free Full Text]
2. Memon AQ, Huang RI, Marcus F, Xavier L, Alpert J. Saphenous vein graft aneurysm: case report and review. Cardiol Rev 2003;11:26–34.[CrossRef][Medline]
3. Topaz O, Rutherford MS, Mackey-Bojack S, Prinz AW, Katta S, Salter D, Titus JL. Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. Cardiovasc Pathol 2005;14:298–302.[CrossRef][Medline]
4. Souza DS, Bomfim V, Skoglund H, Dashwood MR, Borowiec JW, Bodin L, Filbey D. High early patency of saphenous vein graft for coronary artery bypass harvested with surrounding tissue. Ann Thorac Surg 2001;71:797–800.[Abstract/Free Full Text]
5. Tsui JC, Souza DS, Filbey D, Bomfim V, Dashwood MR. Preserved endothelial integrity and nitric oxide synthase in saphenous vein graftharvested by a novel ‘no touch’ technique. Br J Surg 2001;88:1209–1215.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nikolaos Barbetakis Andreas Efstathiou Ioannis Fessatidis Permission Requests Google Scholar Articles by Barbetakis, N. Articles by Fessatidis, I. PubMed PubMed Citation Articles by Barbetakis, N. Articles by Fessatidis, I. Related Collections Related Article