Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency Pranjal Desai, MD, Soroosh Kiani, BS, Nannan Thiruvanthan,

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Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency Pranjal Desai, MD, Soroosh Kiani, BS, Nannan Thiruvanthan, BA, Stanislav Henkin, BA, Dinesh Kurian, BS, Pluen Ziu, MD, Alex Brown, BS, Nisarg Patel, MBBS, Robert Poston, MD The Annals of Thoracic Surgery Volume 91, Issue 5, Pages 1385-1392 (May 2011) DOI: 10.1016/j.athoracsur.2011.01.079 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Intraoperative examination of the saphenous vein (SV). On a sterile back table, veins were cannulated with a Y adapter to allow optical coherence tomography (OCT) images (A) to be obtained from an intraluminal 1F OCT wire (B) while gently distending the vein at 100 mm Hg pressure. As the imaging wire is pulled back from within the saphenous vein graft (SVG; C), it is localized by an infrared light emitted from its tip (arrow, D). Any detected abnormalities, such as a retained thrombus (E) with radial signal attenuation suggesting “red clot” (arrow, F), can then be exactly localized within the vein. (OR = operating room.) The Annals of Thoracic Surgery 2011 91, 1385-1392DOI: (10.1016/j.athoracsur.2011.01.079) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intimal and deep vessel injury after endoscopic vein harvesting. Evidence of injury noted by optical coherence tomography (A, C, E, G, I) was confirmed with registered histologic sections taken from the abnormal regions (B, D, F, H, J). Injury ranged in severity from being isolated to the intimal layer (A, C) to deeper vessel involvement such as a dissection into the medial layer (E) or disruption of the external elastic lamina (G, I). In each of these representative examples, the corresponding histologic section confirmed the diagnosis suggested by optical coherence tomography. (Hematoxylin and eosin stain; magnification ×10.) The Annals of Thoracic Surgery 2011 91, 1385-1392DOI: (10.1016/j.athoracsur.2011.01.079) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions