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OBJECTIVE: Saphenous vein (SV) harvest for coronary bypass via endoscopic technique enables minimum invasive vessel harvest than open method but its impact on conduit quality remains to be determined. We used high-resolution optical coherence tomography (OCT) imaging intraoperatively to identify regions of harvested SV that appear injured and then confirmed this injury using scanning electron microscopy (SEM).
METHODS: Prior to CABG, SV conduits were imaged with a sterile OCT (n=8) to identify intimal injuries. Biopsies were collected, sectioned, glutaraldehyde fixed en face, dehydrated, and prepared for SEM imaging.
RESULTS: OCT and SEM images showed evidence of severe intimal injury on the conduit luminal surface (12.5%) (Fig1a,b). Minor intimal injuries were found in 4 of 8 (50%) of SV valve and ostia (Fig1c,e) as a result of distension. Further, SEM analysis revealed focal platelet presence (Fig.1d). Branch ostia indicated crenated red blood cells (RBC) known as spheroechinocyte entrapped in fibrin mesh. Cautery thermal energy dispersion is most likely responsible for alteration in RBC morphology at vessel branches (Fig.1f).
CONCLUSIONS: Our highly sensitive imaging protocol detected endoluminal injury in the main conduit, activated platelets and crenated RBC found near the ostia of SV branches indicating successful endoscopic vein harvest relies heavily on technician experience and expertise with minimum use of electrocautery.

Figure 1. Areas of denuded enthothelium in SV conduit (a), exposing sub-endothelial connective tissue (b). Injuries were noted on valve with activated platelets (c, d). Endothelial layer disrupted in the branch with spheroechinocyte attached to fibrin thread (e,f).