Comparative results of endoscopic and open methods of vein harvesting for coronary artery bypass grafting: a prospective randomized parallel-group trial

Abstract

BackgroundWe compared wound complications between endoscopic and open great saphenous vein harvesting for coronary artery bypass surgery.MethodsA total of 228 consecutive patients were prospectively randomized into two groups: open vein harvesting (OVH), 115 patients; and endoscopic vein harvesting (EVH), 113 patients. Each group was assessed for post-operative wound complications, pain intensity, and neuropathy in the early post-surgical period. Lymphoscintigraphy of the lower limbs as well as morphological studies of vein walls using light and electron scanning microscopy were performed.ResultsVein harvesting time was shorter for EVH than OVH: 31.8 ± 6.2 min and 40.3 ± 15.8 min, respectively (p < 0.01). There were fewer complications after vein harvesting in the EVH group (11.5 %) than in the OVH group (44.4 %) (р = 0.001). Multivariate analysis showed that diabetes mellitus was the only risk factor for post-surgical complications after OVH (odds ratio = 3.95 %; 95 % confidence interval 1.03–8.6). Lymphoscintigraphic data in the EVH group did not demonstrate considerable disturbances in lymph drainage after surgery. In the OVH group, the accumulation of radiopharmaceutical drugs in the lymphatic nodes reduced two-fold (р ≤ 0.001). Histological evaluation of vein samples did not show considerable damage to the vein wall in either group.ConclusionsUsing electron microscopy of vein fragments, this study demonstrated that EVH reduces wound complications and provides good-quality conduits.

A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery

“…Initial studies reported a near doubling of mortality 18 months after CABG with endoscopically harvested saphenous vein conduits when compared with open vein harvest [14]. Subsequent angiographic studies of patency rates and scanning electron microscopy (SEM) assays of intimal integrity have disputed these conclusions [2,11,15]. Davis et al analysed the long-term (approximately 3 years) patency of vein grafts using contrast-enhanced electron beam CT and showed that graft patency rate of endoscopically harvested veins was better than that of traditionally harvested veins [16].…”

“…EVH also eliminates the need for long leg incisions and increases patient satisfaction [4]. However, before there is widespread general acceptance of endoscopic techniques doubts about its impact on the integrity, quality of the conduit and long-term graft patency need to be addressed [2].…”

“…The conventional open method of saphenous vein graft (SVG) harvest results in significant morbidity in 2 to 24 % of patients [2]. Complications of conventional SVG harvesting include leg incision wound complications, prolonged convalescence and poor cosmetic results resulting in high patient dissatisfaction.…”

“…Saphenous vein is widely used as a vascular conduit in coronary artery bypass grafting due to ease of harvesting, availability and versatility [1,2]. The conventional open method of saphenous vein graft (SVG) harvest results in significant morbidity in 2 to 24 % of patients [2].…”

Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass

“…1,2 Numerous comparisons between EVH and open vein harvest (OVH) of the GSV have been performed for coronary artery bypass, with reports of comparable patency rates and fewer wound complications. [2][3][4][5][6] As the preferred conduit for infrainguinal bypass, 7,8 outcomes for OVH vs EVH of GSV have also been investigated in the vascular surgery literature. Initially, reports showed outcomes that paralleled much of the coronary artery bypass graft (CABG) literature, with comparable patencies of OVH and EVH vein graft.…”