Name: synergizing antegrade endoscopic with bridging vein harvesting for improvement of great saphenous vein graft quality from the lower leg
Uploaded: 2019-11-19T12:00:00
Description: Watch this Scientific Journal Video about Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg at JoVE.com

我们感谢全体外科工作人员的出色技术援助。

这项研究符合《赫尔辛基宣言》。该协议遵循独立机构伦理委员会的指导方针，人类生物材料是在知情书面同意后取得的（道德委员会批准：2018-0037）。
1. 腿的位置
注：患者纳入标准包括冠状动脉疾病史，带有CABG手术的选择性/紧急指示，以及需要至少收获一个静脉旁路移植物，以便完全再血管化。排除了使人衰弱的慢性疾病、紧急手术、深静脉血栓形成...

<ol>
	<li>Kopjar, T., Dashwood, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+Versus+"No-Touch"+Saphenous+Vein+Harvesting+for+Coronary+Artery+Bypass+Grafting:+A+Trade-Off+Between+Wound+Healing+and+Graft+Patency.">Endoscopic Versus "No-Touch" Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: A Trade-Off Between Wound Healing and Graft Patency.</a> Angiology. 67 (2), 121-132 (2016).</li><li>Krishnamoorthy, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+Comparing+Vein+Integrity+and+Clinical+Outcomes+in+Open+Vein+Harvesting+and+2+Types+of+Endoscopic+Vein+Harvesting+for+Coronary+Artery+Bypass+Grafting:+The+VICO+Randomized+Clinical+Trial+(Vein+Integrity+and+Clinical+Outcomes).">Study Comparing Vein Integrity and Clinical Outcomes in Open Vein Harvesting and 2 Types of Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting: The VICO Randomized Clinical Trial (Vein Integrity and Clinical Outcomes).</a> Circulation. 136 (18), 1688-1702 (2017).</li><li>Andreas, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+vein+harvesting+is+influenced+by+patient-related+risk+factors+and+may+be+of+specific+benefit+in+female+patients.">Endoscopic vein harvesting is influenced by patient-related risk factors and may be of specific benefit in female patients.</a> Interactive CardioVascular and Thoracic Surgery. 17 (4), 603-607 (2013).</li><li>Deppe, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+vein+harvesting+for+coronary+artery+bypass+grafting:+a+systematic+review+with+meta-analysis+of+27,789+patients.">Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients.</a> Journal of Surgical Research. 180 (1), 114-124 (2013).</li><li>Kodia, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Graft+patency+after+open+versus+endoscopic+saphenous+vein+harvest+in+coronary+artery+bypass+grafting+surgery:+a+systematic+review+and+meta-analysis.">Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis.</a> The Annals of Thoracic Surgery. 7 (5), 586-597 (2018).</li><li>Krishnamoorthy, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+study+comparing+three+groups+of+vein+harvesting+methods+for+coronary+artery+bypass+grafting:+endoscopic+harvest+versus+standard+bridging+and+open+techniques.">A randomized study comparing three groups of vein harvesting methods for coronary artery bypass grafting: endoscopic harvest versus standard bridging and open techniques.</a> Interactive CardioVascular and Thoracic Surgery. 15 (2), 224-228 (2012).</li><li>Harskamp, R. E., Lopes, R. D., Baisden, C. E., de Winter, R. J., Alexander, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Saphenous+vein+graft+failure+after+coronary+artery+bypass+surgery:+pathophysiology,+management,+and+future+directions.">Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions.</a> Annals of Surgery. 257 (5), 824-833 (2013).</li><li>Paz, M. A., Lupon, J., Bosch, X., Pomar, J. L., Sanz, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+early+saphenous+vein+aortocoronary+bypass+graft+occlusion.+The+GESIC+Study+Group.">Predictors of early saphenous vein aortocoronary bypass graft occlusion. The GESIC Study Group.</a> The Annals of Thoracic Surgery. 56 (5), 1101-1106 (1993).</li><li>Lopes, R. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Project+of+Ex+Vivo+Vein+Graft+Engineering+via+Transfection+IV+(PREVENT+IV)+Investigators.+Relationship+between+vein+graft+failure+and+subsequent+clinical+outcomes+after+coronary+artery+bypass+surgery.">Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators. Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery.</a> Circulation. 125 (6), 749-756 (2012).</li><li>Goldman, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+graft+patency+3+years+after+coronary+artery+bypass+graft+surgery.+Department+of+Veterans+Affairs+Cooperative+Study+Group+No.+297.">Predictors of graft patency 3 years after coronary artery bypass graft surgery. Department of Veterans Affairs Cooperative Study Group No. 297.</a> Journal of the American College of Cardiology. 29 (7), 1563-1568 (1997).</li><li>Sarzaeem, M. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scoring+system+for+predicting+saphenous+vein+graft+patency+in+coronary+artery+bypass+grafting.">Scoring system for predicting saphenous vein graft patency in coronary artery bypass grafting.</a> Texas Heart Institute Journal. 37 (5), 525-530 (2010).</li><li>Yerebakan, C., Kaminski, A., Liebold, A., Steinhoff, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+intramyocardial+stem+cell+therapy+for+the+ischemic+myocardium:+results+of+the+Rostock+trial+after+5-year+follow-up.">Safety of intramyocardial stem cell therapy for the ischemic myocardium: results of the Rostock trial after 5-year follow-up.</a> Cell Transplantation. 16 (9), 935-940 (2007).</li><li>Stamm, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intramyocardial+delivery+of+CD133++bone+marrow+cells+and+coronary+artery+bypass+grafting+for+chronic+ischemic+heart+disease:+safety+and+efficacy+studies.">Intramyocardial delivery of CD133+ bone marrow cells and coronary artery bypass grafting for chronic ischemic heart disease: safety and efficacy studies.</a> The Journal of Thoracic and Cardiovascular Surgery. 133 (3), 717-725 (2007).</li><li>Kinoshita, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+versus+single+internal+thoracic+artery+grafting+in+dialysis+patients+with+multivessel+disease.">Bilateral versus single internal thoracic artery grafting in dialysis patients with multivessel disease.</a> The Heart Surgery Forum. 13 (5), 280-286 (2010).</li><li>Grau, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Propensity+matched+analysis+of+bilateral+internal+mammary+artery+versus+single+left+internal+mammary+artery+grafting+at+17-year+follow-up:+validation+of+a+contemporary+surgical+experience.">Propensity matched analysis of bilateral internal mammary artery versus single left internal mammary artery grafting at 17-year follow-up: validation of a contemporary surgical experience.</a> European Journal of Cardio Thoracic Surgery. 41 (4), 770-776 (2012).</li><li>Lytle, B. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+bilateral+internal+thoracic+artery+grafting+on+survival+during+20+postoperative+years.">The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years.</a> The Annals of Thoracic Surgery. 78 (6), 2005-2014 (2004).</li><li>Lytle, B. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prolonging+patency--choosing+coronary+bypass+grafts.">Prolonging patency--choosing coronary bypass grafts.</a> The New England Journal of Medicine. 351 (22), 2262-2264 (2004).</li><li>Kiani, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+venous+harvesting+by+inexperienced+operators+compromises+venous+graft+remodeling.">Endoscopic venous harvesting by inexperienced operators compromises venous graft remodeling.</a> The Annals of Thoracic Surgery. 93 (1), 11-18 (2012).</li><li>Nezafati, M. H., Nezafati, P., Amoueian, S., Attaranzadeh, A., Rahimi, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immunohistochemistry+comparing+endoscopic+vein+harvesting+vs.+open+vein+harvesting+on+saphenous+vein+endothelium.">Immunohistochemistry comparing endoscopic vein harvesting vs. open vein harvesting on saphenous vein endothelium.</a> Journal of Cardiothoracic Surgery. 9, 101 (2014).</li><li>Garc&#237;a-Alt&#233;s, A., Peir&#243;, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+cost-effectiveness+evidence+of+endoscopic+saphenous+vein+harvesting:+is+it+efficient.">A systematic review of cost-effectiveness evidence of endoscopic saphenous vein harvesting: is it efficient.</a> European Journal Of Vascular And Endovascular Surgery. 41 (6), 831-836 (2011).</li><li>Rustenbach, C. J., Wachter, K., Franke, U. F. W., Baumbach, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expanding+Surgical+Opportunities:+Endoscopic+Harvesting+of+the+Vena+Saphena+Parva+in+Supine+Position.">Expanding Surgical Opportunities: Endoscopic Harvesting of the Vena Saphena Parva in Supine Position.</a> The Thoracic and Cardiovascular Surgeon. 65 (4), 322-324 (2017).</li><li>Raja, S. G., Sarang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+vein+harvesting:+technique,+outcomes,+concerns+&amp;+controversies.">Endoscopic vein harvesting: technique, outcomes, concerns &amp; controversies.</a> Journal of Thoracic Disease. 5, 630-637 (2013).</li><li>Desai, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+the+learning+curve+for+endoscopic+vein+harvest+on+conduit+quality+and+early+graft+patency.">Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency.</a> The Annals of Thoracic Surgery. 91, 1385-1392 (2011).</li><li>Luckraz, H., Cartwright, C., Nagarajan, K., Kaur, P., Nevill, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Major+adverse+cardiac+and+cerebrovascular+event+and+patients'+quality+of+life+after+endoscopic+vein+harvesting+as+compared+with+open+vein+harvest+(MAQEH):+a+pilot+study.">Major adverse cardiac and cerebrovascular event and patients' quality of life after endoscopic vein harvesting as compared with open vein harvest (MAQEH): a pilot study.</a> Open Heart. 5, 000694 (2018).</li><li>Khan, S. Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+vein+harvest+does+not+negatively+affect+patency+of+great+saphenous+vein+lower+extremity+bypass.">Endoscopic vein harvest does not negatively affect patency of great saphenous vein lower extremity bypass.</a> Journal of Vascular Surgery. 63 (6), 1546-1554 (2016).</li><li>Santo, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Open+versus+endoscopic+great+saphenous+vein+harvest+for+lower+extremity+revascularization+of+critical+leg+ischemia.">Open versus endoscopic great saphenous vein harvest for lower extremity revascularization of critical leg ischemia.</a> Journal of Vascular Surgery. 59 (2), 427-434 (2014).</li></ol>

应该说，我们更喜欢完全动脉冠状动脉再血管化在我们的部门。越来越多的证据表明，CABG使用双边内部乳腺动脉（IMA）移植可以显著提高患者的长期生存14，15，16，17。然而，有正当理由采用"单IMA加静脉移植"策略，特别是在高龄患者、手术部位感染高风险患者、无法获得径向动脉移植的患者以及慢?...

开放创伤性"低接触"和"无接触"技术已发展多年，用于在冠状动脉旁路移植（CABG）手术或外周旁路移植中收获树液静脉，产生具有优异内皮完整性和长期性移植的移植物。然而，伤口并发症仍然是使用开放技术的主要问题，特别是在肥胖，糖尿病和慢性静脉功能不全患者1，2，3，4。问题出现了，医生如何收获沙文静脉与最佳的移植质量和降低伤口并发症的风险。内窥镜静脉采集（EVH）技术已被证明具有成本效益，临床结果参数可与开放技术相媲美。然而，为了保护EVH期间静脉移植的内皮完整性、组织结构和生理功能，为了保持最佳移植质量2，人们高度赞赏保护静脉移植的策略。与内窥镜技术5相比，最近的研究在开放收获后具有优异的移植性。还表明，桥接静脉收获技术可以直接提高静脉质量6。因此，假设静脉移植收获可以通过在无张力工作通道中与微创桥静脉收获、特定腿部定位和静脉隔离进行协同前坡 EVH 推进。
迄今为止，传统的EVH技术用于采集大树脉，已经使用前腿和前坡方法，为小腿逆行方法。然而，我们经历了这些技术的局限性，并持有有关移植质量的关注。膝盖和上肢的大沙骨静脉经常露出许多侧枝，偶尔显示膨胀的血管直径，导致船舶质量受损，导管和目标血管不匹配，在CABG和再血管化率7、8、9、10、11之后，会对长期移植性产生负面影响。根据我们的经验，小腿的逆行EVH方法反复导致血管内长期失血（由于封闭的静脉瓣膜导致静脉血压升高），组织机械应力增加，出血，血栓形成，移植损伤，移植质量受损。因此，该标准化协议是为从小腿安全前体EVH开发的，将微创访问部位的桥接静脉采集技术与前坡EVH结合在无张力工作通道中，实现足够的静脉移植质量。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>disposable scalpel (size 11, Pr&#228;zisa Plus)</td>
			<td>Dahlhausen, Germany</td>
			<td></td>
			<td>a</td>
		</tr>
		<tr>
			<td>small curved smooth (anatomical) clamps </td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>b</td>
		</tr>
		<tr>
			<td>toothed (surgical) forceps</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>c</td>
		</tr>
		<tr>
			<td>surgical scissors </td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>d</td>
		</tr>
		<tr>
			<td>holder for scalpel blade (size 10)</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>e</td>
		</tr>
		<tr>
			<td>fine smoth (anatomical) forcep</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>f</td>
		</tr>
		<tr>
			<td>sponge-holding clamp</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>g</td>
		</tr>
		<tr>
			<td>clipping device</td>
			<td>Fumedica, Switzerland</td>
			<td></td>
			<td>h</td>
		</tr>
		<tr>
			<td>18 Gauge cannula (Sterican)</td>
			<td>B. Braun, Germany</td>
			<td></td>
			<td>i</td>
		</tr>
		<tr>
			<td>light handle</td>
			<td>Simeon Medical, Germany</td>
			<td></td>
			<td>j</td>
		</tr>
		<tr>
			<td>needle holder</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>k</td>
		</tr>
		<tr>
			<td>tissue retractor</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>l</td>
		</tr>
		<tr>
			<td>Redon needle</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>m</td>
		</tr>
		<tr>
			<td>adhesive hook and loop fastener</td>
			<td>M&#246;lnlycke, Germany</td>
			<td></td>
			<td>n</td>
		</tr>
		<tr>
			<td>extended length endoscope </td>
			<td>Karl Storz, Germany</td>
			<td></td>
			<td>o</td>
		</tr>
		<tr>
			<td>optical cable</td>
			<td>Karl Storz, Germany</td>
			<td></td>
			<td>p</td>
		</tr>
		<tr>
			<td>transparent drap camera cover</td>
			<td>ECOLAB Healthcare, Germany</td>
			<td></td>
			<td>q</td>
		</tr>
		<tr>
			<td>connection cable for electrocauterisation</td>
			<td>Maquet, Getinge Group, Germany </td>
			<td></td>
			<td>r</td>
		</tr>
		<tr>
			<td>gas insufflation set</td>
			<td>Dahlhausen, Germany</td>
			<td></td>
			<td>s</td>
		</tr>
		<tr>
			<td>Fred Anti-Fog Solution </td>
			<td>Medtronic, USA</td>
			<td></td>
			<td>t</td>
		</tr>
		<tr>
			<td>bipolar electrocoagulation device </td>
			<td>Maquet, Getinge Group, Germany </td>
			<td></td>
			<td>u</td>
		</tr>
		<tr>
			<td>monitor (WideView)</td>
			<td>Karl Storz, Germany</td>
			<td></td>
			<td>v</td>
		</tr>
		<tr>
			<td>light source (xenon 300)</td>
			<td>Karl Storz, Germany</td>
			<td></td>
			<td>w</td>
		</tr>
		<tr>
			<td>gas insufflation controller (Endoflator)</td>
			<td>Karl Storz, Germany</td>
			<td></td>
			<td>x</td>
		</tr>
		<tr>
			<td>half-cylindrical foam roller</td>
			<td>Almatros, Gebr. Albrecht KG, Germany</td>
			<td></td>
			<td>y</td>
		</tr>
		<tr>
			<td>full-cylindrical foam roller</td>
			<td>Almatros, Gebr. Albrecht KG, Germany</td>
			<td></td>
			<td>z</td>
		</tr>
		<tr>
			<td>bulldog clamp</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>aa</td>
		</tr>
		<tr>
			<td>flexible vessel cannula</td>
			<td>Medtronic, USA</td>
			<td></td>
			<td>ab</td>
		</tr>
		<tr>
			<td>vessel loop (Mediloops)</td>
			<td>Dispomedica, Germany</td>
			<td></td>
			<td>ac</td>
		</tr>
		<tr>
			<td>Heparin-Natrium (5000 U) in 200ml saline</td>
			<td>B. Braun, Germany</td>
			<td></td>
			<td>ad</td>
		</tr>
		<tr>
			<td>Langenbeck hooks</td>
			<td>B. Braun Aesculap, Germany</td>
			<td></td>
			<td>ae</td>
		</tr>
		<tr>
			<td>sutures (polygalctin 910, Vicryl 2-0, 4-0; poly ethylene terephthalate, Ethibond 2-0)</td>
			<td>Ethicon, Johnson &#38; Johnson, USA</td>
			<td></td>
			<td>af</td>
		</tr>
		<tr>
			<td>Endoscopic vessel harvesting system, Vasoview Hemopro II</td>
			<td>Maquet, Getinge Group, Germany </td>
			<td></td>
			<td>ag</td>
		</tr>
		<tr>
			<td>Octenidindihydrochloride, Octeniderm</td>
			<td>Schuelke &#38; Mayr GmbH, Germany</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

synergizing antegrade endoscopic with bridging vein harvesting for improvement of great saphenous vein graft quality from the lower leg

用于旁路移植的自动移植的超量内窥镜采集可能是解决优异的移植质量和减少术后伤口并发症的最佳策略。这种用于从小腿进行前体内窥镜静脉采集（EVH）的标准化方案有可能引入常规冠状动脉旁路移植（CABG）。接受CABG手术的患者被放置在手术台上，在延长的腿部下方有两个额外的泡沫滚筒，使小腿的EVH水平达到水平。通过桥接静脉采集技术进行微创手术后，将内窥镜光学分段插入伤口。在静脉质量状态和工作通道的连续光学控制下，对主容器和侧分支进行解剖。之后，使用内部双极电凝装置插入内窥镜光学缩回器，用于对侧枝进行精确、安全和组织保护的中断。静脉释放后，在光学控制下，在近端和远端切断血管，从伤口中取回，然后用肝素化盐水进行甲酸盐冲洗。最后，静脉移植的所有侧分支都双夹。在静脉样本的随机选择中分析血管体学。应用此标准化EVH方案后，学习曲线显示陡峭，移植质量足以用于冠状动脉旁路移植。没有转换到手术收获和低风险的组织损伤和出血。腿部定位和协同EVH与桥接静脉收获提高了程序成功和静脉移植质量。在我们手中，从小腿的前坡EVH是可行的，表明直接的移植解剖，以及足够的宏观和微观移植质量与保留的内皮完整性。总之，所介绍的技术是安全的，显示了优良的静脉自移植质量，并说明了选择性和紧急隔离CABG和CABG组合方案的可行性。

一个经验丰富的心脏外科医生从小腿上执行大沙叶静脉前坡EVH的陡峭学习曲线（图4）。没有转换到手术收获。然而，在学习曲线的开始有四例静脉损伤。在四个病例中的三个病例中，由于外科医生在静脉转移上方分离静脉时，由于工作通道狭窄不足，导致静脉远端发生重大损伤。在两种情况下，一个主要侧枝发生断裂，一个病例的远端静脉被撕裂，导致静脉的远端部分被丢...

Watch this Scientific Journal Video about Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg at JoVE.com

Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg

这里介绍的是一个从小腿采集前体内窥镜静脉的方案，可以安全地引入常规冠状动脉旁路移植。静脉移植物提供优良的移植质量遵循这个标准化协议与腿的定位，微创访问静脉，和前向内窥镜静脉收获。

协同前体内窥镜与桥接静脉收获，提高从下腿大萨普努斯静脉移植质量

Antegrade endoscopic harvesting of autografts for bypass grafting may be an optimal strategy addressing excellent graft quality and reduced post-operative ...

我们的前腔内静脉采集方案可能是解决出色的静脉移植质量和伤口愈合和常规冠状动脉旁路手术的最佳策略。使用过渡静脉采集技术合成前部内窥镜，在选择性和紧急情况下，能够对小腿的优质静脉移植进行微创和组织保护性隔离。在开始手术之前，将内窥镜静脉采集的仪器设置放在桌子的末尾附近，并在患者的长腿下方的跟腱下方放置一个 60 厘米长、直径 12 厘米的泡沫辊。然后将膝盖上方的半圆柱形泡沫辊放在移植物的一侧，以避免膝盖过度拉伸和常见的周内神经病变。为了获得对亚芬静脉的微创，首先使用机构标准消毒程序、盐酸八角胺和标准无菌覆盖物，以达到无菌手术条件。接下来，从想象中的脚踝关节上方的大约一个食指开始，向上平行于头骨的中缘，使用弯曲的数字10手术刀在小腿做一个点五到两厘米的纵向皮肤切口。然后，从皮肤切口开始，使用血管循环解剖剪刀、小软组织缩回器和 langem 贝克钩，通过应用标准的过渡静脉采集技术，在每个方向分离容器四厘米。注意避免收获静脉曲张。并确保一个小手指可以轻松地访问工作通道。在开始手术之前，将延长长度的内窥镜连接到光学相机，并连接内窥镜收集系统中的解剖尖端以组装光学解剖器。用含有肝素的盐水水合光学解剖器，并在光学解剖器上放置一个水合充气阻滞气球。然后轻轻地将光学解剖器前行和充气阻滞气球插入静脉永久光学控制的伤口。用10毫升的房间空气阻挡充气阻滞气球，用二氧化碳淹没工作通道。确认工作通道由气体压力延伸，并移动解剖器前行，直到到达三室体膜的想象近中端。轻轻地将光学解剖器移动到主容器上方和下方，将容器与大多数皮下组织分离，直到获得对侧枝的清晰识别。注意尽可能保持周围血管组织的完整性，以预防移植伤害和最大限度地减少工作通道内的机制。然后选择性地解剖静脉一侧的侧枝，尽可能保存周围血管组织，然后再解剖另一侧。接下来，从伤口上取出光学解剖器，并断开解剖尖端。调整光学缩回器的阻滞球，用五毫升注射器阻断工作通道。要组装光学缩回器，请将伸长内窥镜连接到内窥镜收集系统中的缩回器装置。然后将防雾液涂抹到内窥镜的尖端，用盐水补充肝素来滋润光学缩回器，然后通过阻塞的气球进行前行插入。当缩回器准备就绪时，将设备前进到工作通道的末尾。使用缩回器有选择地用双极电凝固装置以逆行方式中断侧枝，以从周围的皮下组织中释放静脉。如果光学相机的视力受到干扰，用肝素盐水冲洗光学相机的镜头。当萨芬静脉被完全隔离时，使用11号手术刀在解剖静脉的端端的皮肤中执行刺切口。通过切口插入平滑的解剖夹。使用光学缩回器将静脉夹在光学控制下，并通过刺切口轻轻取回静脉。在通过阻塞的气球轻轻取出光缩回器之前，将静脉近开，同时释放静脉的离骨部分。将阻滞气球放气，并将其从伤口上取下。然后关掉二氧化碳。要完成桥接静脉采集，在皮肤上执行刺切，在隔离静脉的近端用尖锐的11号手术刀，比想象中的脚踝关节高出大约三厘米。通过刺切口插入解剖夹，在数字和光学控制下通过皮肤切口检索静脉，同时避免对盐神经造成伤害，并在直接视觉下夹住静脉。然后通过最初的微创手术接触点轻轻切除静脉，然后用三英里仪柔性血管将近端进行。在关闭伤口之前，使用 10 毫升注射器用盐水轻轻冲洗释放的静脉移植物，并辅以肝素，并交替进行所有侧枝的双剪。将静脉移植物储存在盐水中，肝素在室温下浸泡压缩。然后分别使用 2-O 和 4-O 多糖蛋白 910 缝合线在微创访问场执行皮下和皮内伤口闭合。这里显示的是后续冠状动脉旁路手术后利用的静脉移植。这些数据表明，经验丰富的心脏外科医生需要从28名患者的小腿中成功完成大下垂静脉的骨静脉收获所需的陡峭学习曲线。该图说明了从插入光学解剖器到静脉移植检索终止，时间消耗立即动态减少。这些随机的盲显微分析揭示了在产前内窥镜静脉收获后，所有分析的静脉样本的完整血管形态和完全保留的内皮完整性。记住三个基本要素是最重要的。腿部定位、外侧定向桥接静脉采集、组织保护前侧内窥镜静脉采集。我们的方案可以帮助心脏和血管外科医生在选择性和紧急情况下制定自己的最佳策略，实现高质量的静脉移植分离。这个一步一步的视频应该可以帮助你准备高品质的静脉内窥镜静脉采集。

Research

JoVE Journal

Medicine

Training a Sophisticated Microsurgical Technique: Interposition of External Jugular Vein Graft in the Common Carotid Artery in Rats

培养一个精密的显微外科技术在大鼠颈总动脉，颈外静脉移植：介入

Neointimal hyperplasia is one the primary causes of stenosis in arterialized veins that are of great importance in arterial coronary bypass surgery, in ...

科研

医学

Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency

静脉介入型号：研究旁路移植通畅一个合适的模型

Bypass grafting is an established treatment method for coronary artery disease. Graft patency continues to be the Achilles heel of saphenous vein grafts. ...

Repeated Blood Collection from Tail Vein of Non-Anesthetized Rats with a Vacuum Blood Collection System

无麻醉大鼠尾静脉血采集系统的研究

Blood can be collected from rats in a number of sampling locations. For instance, the tail vein is a superior location for blood sampling. However, the ...

Blood Collection Through Subclavian Vein Puncture in Mice

小鼠锁骨下静脉穿刺采血

The mouse is the foremost mammalian model for studying human disease and human health. However, blood sample collection from mice is challenging in ...

Using a Chemical Biopsy for Graft Quality Assessment

使用化学活检进行移植质量评估

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...

Repetitive Blood Sampling from the Subclavian Vein of Conscious Rat

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to ...

Establishment and Evaluation of a Porcine Vein Graft Disease Model

猪静脉移植病模型的建立与评价

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the ...

Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane

使用基于氰基丙烯酸正丁酯和甲基丙烯酰氧基环丁基磺烷的共聚物胶咬合大隐脉和小隐脉

We present the preliminary results of a longitudinal observational study aimed at evaluating the effectiveness and safety at different short- and ...

Human Saphenous Vein Endothelial Cell Isolation and Exposure to Controlled Levels of Shear Stress and Stretch

人隐静脉内皮细胞分离和暴露于受控水平的剪切应力和拉伸

Coronary artery bypass graft (CABG) surgery is a procedure to revascularize ischemic myocardium. Saphenous vein remains used as a CABG conduit despite the ...

Comparative Study of Blood Collection Techniques in Rats

Modified Tail Vein and Penile Vein Puncture for Blood Sampling in the Rat Model

Context Dependent Blood Collection Methods in Rats (Video) | JoVE

改良尾静脉和静脉穿刺用于大鼠模型中的血液采样

Blood samples are required in most experimental animal designs to assess various hematological parameters. This paper presents two procedures for blood ...