Above-Knee Vein Harvest for Coronary Revascularization Increases ASEPSIS Score

Abstract

The long saphenous vein may be harvested from the thigh or the lower leg, depending on the operating surgeon's preference. This prospective study compared the incidence of altered wound healing between these two sites in 175 patients undergoing routine coronary artery bypass grafting over a 3-month period. The patients were divided into 3 groups. In group A, the vein harvest site was restricted to above the upper border of the patella. Group B included harvest sites that started at the ankle but extended above the level of the upper border of the patella. In group C, the vein harvest site was restricted to below the upper border of the patella. The wounds were assessed daily using the ASEPSIS scoring system. In group A, significantly more patients (24%) had an ASEPSIS score > 10, compared to group B (3%) and group C (2%). The mean ASEPSIS score was significantly lower in group C than groups A or B, 1.5 +/- 2.4 vs. 6.5 +/- 3.2 or 3.7 +/- 1.7, respectively. The ASEPSIS score is reduced when vein harvest is restricted to below the level of the knee.

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial☆

“…In a prospective observational study it has been shown that the ASEPSIS score was reduced when vein harvest was restricted to below the level of the knee [20]. In the OVH group all veins but two were harvested below the knee, but this did not result in lower wound morbidity compared to EVH from the thigh.…”

Reduction of surgical site infection using a microbial sealant: A randomized trial

“…We also used the below-knee portion of the vein in most of the patients for grafting because we have encountered increased wound infections in the thigh region. According to Akowuah and colleagues, 23 the ASEPSIS score (Additional treatment, Serous discharge, Erythema, Purulent exudates, Separation of deep tissues, Isolation of bacteria, Stay in hospital prolonged over 14 days) is reduced when vein harvest is restricted to below the level of the knee. This study found that the use of a microbial sealant before incision significantly reduced the rate of leg wound infections among patients undergoing CABG.…”