Abstract The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.
Abstract With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.
Abstract: Introduction: The “Pediatric Appendicitis Score”, is a tool for the evaluation of abdominal pain in children and defines the probability of appendicitis, using an objective scale that assesses the presence of 8 signs and symptoms. Aim: To demonstrate the usefulness of Pediatric Appendicitis Score for abdominal pain applied in an emergency. Material and methods: An observational, prospective and longitudinal study in the Pediatric Appendicitis Score was adopted as a quick tool for the diagnosis of appendicitis was performed acute, was determined to employ a population of 250 patients by convenience. Male and female patients with acute abdominal pain were included, between six months and 17 years old. Those patients whose relatives refused participation in the study were excluded. They were eliminated subjects prior to admission medication, deficiencies in filling the instrument, who requested voluntary discharge without having completed the study protocol, and those who did not attend the reassessment to 48 hours. Results: The total sample (n = 232), of which 31% (n = 72) had appendicitis; 77% (n = 55) were men, 23% (n = 17) women. The grade obtained in the score, average was 7.59 ± 2.052, with an average of 9.02 ± 5.32 hours of evolution.
Resumen: Introducción: La Escala Pediátrica para Apendicitis es una herramienta para la valoración del dolor abdominal en niños y define la probabilidad de apendicitis, mediante una escala objetiva que valora la presencia de ocho signos y síntomas. Objetivo: Demostrar la utilidad de la Escala Pediátrica para Apendicitis para el dolor abdominal aplicado en un Servicio de Urgencias en una población mexicana. Material y métodos: Se realizó un estudio observacional, prospectivo y longitudinal en el que se adoptó la Escala Pediátrica para Apendicitis como herramienta rápida para el diagnóstico de apendicitis aguda. Se determinó emplear una población a conveniencia de 250 pacientes. Se incluyeron pacientes de uno u otro sexo con dolor abdominal agudo, entre los seis meses y 17 años de edad. Se excluyeron aquellos casos con medicación previa a su ingreso, deficiencias en el llenado del instrumento, alta voluntaria sin haber terminado el protocolo de estudio y quienes no acudieron a la revaloración a las 48 horas. Resultados: Del total de la muestra (n = 232), el 31% (n = 72) tuvo apendicitis; el 77% (n = 55) fueron hombres, 23% (n = 17) mujeres. La calificación que obtuvieron en la escala fue de 7.59 ± 2.052, con un promedio de 9.02 ± 5.32 horas de evolución.