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DOI: 10.1055/s-0034-1367302
New clip remover device to prepare saphenous vein graft for coronary bypass grafting
Objective: The accurate prepare of the saphenous vein (SV) is elementary to have good patency rates in myocardial revascularisation. To avoid intimal hyperplasia we use the eSVS Mesh (Kipps Bay Medical™, Minneapolis, USA). Caused by endoscopic harvesting technique of SV all side branches are clipped in situ. All Clips have to be removed and replaced by fine sutures (Prolene 6-0) in order to enable the covering the SV with the eSVS. How to remove the Clips without tearing the SV and its intima?
Methods: We use a new designed clip remover in 40 patients. After harvesting the SV the distal end is intubated by a cannula with outlet. Into the SV a solution of sodium chloride 0.9% is applicated with a maximum pressure of 150 cm H2O. So the clips are exposed in a good position and they can be reopened and removed without sheer stress to the tissue by the clip remover device. Intraoperative graft patency was verified by MediStim.
Result: All clips could be removed from vein. No tear that had to be repaired. Graft patency was 95% for eSVS treated with the new device. Histologic findings showed no intima lesions.
Conclusion: This new tool is very feasible and save. Wrong placed clips on mammarian artery or veins are now easy and safely removable and a new can be applicated in correct position considering the potential intima lesion of the graft by clipping.