Hey, Hey, Hey. Don’t be rough! You’ve got to be delectate, be gentle. You can’t just manhandle the graft. It’s probably the patient's first time. Be considerate. Take it easy. In fact, it might be better if you didn’t touch it at all…

Coronary artery bypass grafting(CABG) isn't new. When you can’t balloon and stent the occluded vessel, you have to replace it. Arterial grafts may be preferred, but 80% of all grafts used are saphenous vein grafts(SVG’s).

Therein lies our problem… SVG’s love to fail.
10-15% fail after one year and that number increases with time. This results in adverse outcomes like angina, MI’s and death. All that surgical effort just to get blocked again in 12 months. Why might that be?

The PATENCY trial, conducted in China and published in the BMJ, thinks it might have something to do with the vein harvesting technique.

Traditionally, we strip off the vein’s outer layer(adventitia) and inflate the vein like a bike tire. The “no-touch” technique skips the abuse. It leaves the vein's outer structure and surrounding tissue intact. Theoretically preserving the endothelium and reducing inflammation, thus reducing occlusion risk.

The theory checks out. So they tested it.

A multi-centre RCT with over 2,600 patients, tracking outcomes for three years after surgery. The big question: does this technique actually keep veins open longer?

Outcomes?

Vein graft occlusion at year 3: No touch: 5.7%. Traditional: 9.0%.

Non-fatal MI’s: No touch: 1.1%. Traditional: 2.2%.

Repeat revascularization: No touch: 6.2%. Traditional: 8.4%.

Readmission for cardiac arrest: No touch: 7.1%. Traditional: 10.2%

So regarding the heart itself. We have a clear winner. However, let's not forget about the leg we took the thing from. Leg wound complications requiring surgical intervention were significantly higher than in the traditional group(10.3% vs 4.3%, odds ratio: 2.55).

So your heart might rejoice, but your leg will certainly file a formal complaint. Still, if keeping the graft open means one less trip to the cath lab? It might be worth the limp.

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The BMJ that this story is based off of has a really nice visual abstract Check it out