Early experience of endoscopic vein harvesting for CABG

Abstract

Objectives: As the traditional method of saphenous vein harvesting is associated with nagging leg wound problems, we tried to incorporate this relatively new technique of endoscopic vein harvesting (EVH) in to our regular coronary artery bypass grafting (CABG) Programme.Methods: Selected patients (based on affordability, obesity, availability of operator and vein quality on inspection) were offered endoscopic vein harvesting (EVH) for CABG. Vasoview 6 (Guidant, U.S.A) Endoscopic dissector was used with carbon dioxide insufflation. As this was our initial experience, only thigh veins were tried. If additional veins were required or the endoscopically harvested veins were of unacceptable quality, additional vein was harvested by open method. Impacts on cost and operative time, discard rate and leg wound complications were noted. Results: We have so far attempted EVH on 86 patients. In one (first), the whole vein had to be discarded and in two others, parts of the vein were not used. Additional vein harvesting was done in 4 patients. EVH was converted to Vein stripping in one patient due to bleeding while branch division and poor visibility. No leg wound complications occurred in any of these patients. Additional time spent was approximately 45-50mts in the first few patients. Of late this has reduced to 25-30 mts. Additional material cost was Rs.3000 per patient.Conclusion: With experience, EVH can be a valuable additional tool in the CABG set up with the advantage of reduced leg incision and consequent reduction in leg wound problems with minimal increase in the operative time and cost. (Ind J Thorac Cardiovasc Surg, 2007; 23: 188-191)

Effect of Endoscopic Versus Open Saphenous Vein Harvesting Technique on Leg Wound Complications

“…Patients are satisfied by small incision and absence of leg wound discomfort. As the experience grows, learning curve is required to become familiar with EVH [2] . Postoperative leg pain, mobilization, and overall patient satisfaction were also significantly improved in study EVH group.…”

“…OVH is associated with long incisions and consequent associated pain and other complications [2] .OVH harvesting includes leg wound complications, prolonged convalescence and poor cosmetic results resulting in patient dissatisfaction. It may prolong a hospital stay or require readmission for debridement, or IV antibiotics.…”

Leg Wound Complications: A Comparison Between Endoscopic and Open Saphenous Vein Harvesting Techniques

“…Patients are satisfied by the small incision and absence of leg wound discomfort. As experience grows, a learning curve is required to become familiar with EVH [Raghuram 2007]. Postoperative pain, mobilization, and patient satisfaction were significantly improved in the EVH group.…”

“…Leg wound complications include prolonged wound healing, hospital stay, and poor cosmetic outcome. It may require readmission for debridement or IV antibiotics [Raghuram 2007]. EVH is a less invasive technique and associated with 2% to 5% incidence of wound complications.…”