Does No-Touch Technique Better than Conventional or Intermediate Saphenous Vein Harvest Techniques for Coronary Artery Bypass Graft Surgery: a Systematic Review and Meta-analysis
Saphenous vein (SV) is a common graft being used in coronary artery bypass grafting (CABG). Conventional (CON), intermediate (I), and no-touch (NT) are the most common harvesting techniques of SV for CABG. The aim of this study is to systematically review the NT versus CON and I techniques in harvesting SV for CABG. Twelve databases were searched for randomized controlled trials comparing the CON, I, and NT techniques in harvesting SV for CABG. Twelve reports of six RCTs were included. Our meta-analysis showed that with NT technique, patency rate was significantly higher when compared to I technique up to 18-month follow-up duration. In contrast, this significant difference was not maintained in terms of minor complications of leg wounds with both techniques. The NT has significantly higher patency rate compared to I vein harvesting technique. However, more RCTs are warranted to confirm these results.
KeywordsConventional Intermediate No-touch Saphenous vein CABG Patency rate
Study concept and design: N.T.H., A.E., N.L.V.; researched data and drafting the manuscript: A.E., A.H.B., H.T.V., A.R.A., M.A.M., A.L.S., N.L.V., I.A.E., N.A.A., V.T.V.; and critical revision of manuscript for important intellectual content: A.E., A.H.B., N.L.V., N.T.H., K.H.
This study was not funded by any means.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
No human studies were carried out by the authors for this article.
- 2.Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., et al. (2015). Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. https://doi.org/10.1161/CIR.0000000000000350.
- 3.Rosamond, W., Flegal, K., Furie, K., Go, A., Greenlund, K., Haase, N., et al. (2008). Heart disease and stroke statistics—2008 update. A report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation, 117, e25–e146. https://doi.org/10.1161/CIRCULATIONAHA.107.187998.CrossRefPubMedGoogle Scholar
- 5.Cao, C., Manganas, C., Horton, M., Bannon, P., Munkholm-larsen, S., & Ang, S. C. (2012). Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: a meta-analysis of randomized controlled trials. The Journal of Thoracic and Cardiovascular Surgery, 146(2), 255–261. https://doi.org/10.1016/j.jtcvs.2012.07.014.CrossRefPubMedGoogle Scholar
- 12.Souza, D. S., Johansson, B., Bojö, L., Karlsson, R., Geijer, H., Filbey, D., et al. (2006). Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. The Journal of Thoracic and Cardiovascular Surgery, 132(2), 373–378.CrossRefGoogle Scholar
- 14.Huy, N. T., Elshafay, A., Vuong, N. L., Bendary, A. H., Mokhtar, M. A., Vuong, T. H., et al. (2017). Comparison of conventional and no-touch techniques in harvesting saphenous vein for coronary artery bypass grafting: a systematic review. PROSPERO, CRD42017062269. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017062269.
- 16.Higgins, J. P. T., & Green, S. E. (2011). Cochrane handbook for systematic reviews of interventions Version 5.1.0. London: The Cochrane Collaboration.Google Scholar
- 17.Johansson, B., Samano, N., Souza, D., Bodin, L., Filbey, D., Mannion, J. D., et al. (2015). The no-touch vein graft for coronary artery bypass surgery preserves the left ventricular ejection fraction at 16 years postoperatively: long-term data from a longitudinal randomised trial. Open Heart, 2(1), e000204.CrossRefGoogle Scholar
- 20.Samano, N., Geijer, H., Liden, M., Fremes, S., Bodin, L., & Souza, D. (2015). The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: a randomized trial. The Journal of Thoracic and Cardiovascular Surgery, 150(4), 880–888.CrossRefGoogle Scholar
- 21.Souza, D. S., Dashwood, M. R., Tsui, J. C., Filbey, D., Bodin, L., Johansson, B., et al. (2002). Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques. The Annals of Thoracic Surgery, 73(4), 1189–1195.CrossRefGoogle Scholar
- 22.Johansson, B. L., Souza, D. S., Bodin, L., Filbey, D., Loesch, A., Geijer, H., et al. (2010). Slower progression of atherosclerosis in vein grafts harvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. European Journal of Cardio-Thoracic Surgery, 38(4), 414–419.CrossRefGoogle Scholar
- 26.Verma, S., Lovren, F., Pan, Y., Yanagawa, B., Deb, S., Karkhanis, R., et al. (2014). Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study. European Journal of Cardio-Thoracic Surgery, 45(4), 717–725.CrossRefGoogle Scholar
- 27.Silva, V. F., Ishigai, M. M., Freymüller, E., Branco, J. N., Gaia, D. F., Gabriel, E. A., et al. (2008). Microscopic and ultrastructural evaluation of the saphenous vein endothelium for CABG prepared by the no touch technique. Revista Brasileira de Cirurgia Cardiovascular, 23(3), 232–239.Google Scholar
- 30.Windecker, S., Kolh, P., Alfonso, F., Collet, J. P., Cremer, J., Falk, V., et al. (2014). 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal, 35(37), 2541–2619.CrossRefGoogle Scholar
- 35.Khaleel, M. S., Dorheim, T. A., Duryee, M. J., Durbin, H. E., Bussey, W. D., Garvin, R. P., et al. (2012). High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure. The Annals of Thoracic Surgery, 93, 552–558.CrossRefGoogle Scholar
- 36.Goldman, S., Copeland, J., Moritz, T., Henderson, W., Zadina, K., Ovitt, T., et al. (1989). Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. Results of a veterans administration cooperative study. Circulation, 80(5), 1190–1197.CrossRefGoogle Scholar
- 37.Shah, P. J., Gordon, I., Fuller, J., Seevanayagam, S., Rosalion, A., Tatoulis, J., et al. (2003). Factors affecting saphenous vein graft patency: clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999. The Journal of Thoracic and Cardiovascular Surgery, 126(6), 1972–1977.CrossRefGoogle Scholar
- 41.Suma, H. (1999). Arterial grafts in coronary bypass surgery. The Annals of Thoracic Surgery, 5, 141–144.Google Scholar
- 42.Khot, U. N., Friedman, D. T., Pettersson, G., Smedira, N. G., Li, J., & Ellis, S. G. (2004). Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation, 109(17), 2086–2091.CrossRefGoogle Scholar