Endoscopic Vein Harvesting for Coronary Bypass Grafting: A Blessing or a Trojan Horse?

Abstract

Conventional open harvest of the great saphenous vein (GSV) during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH) the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.

Comparison of Conventional Technique and Ultrasonographic Mapping in Saphenous Vein Harvesting

“…EVH is a method used with increasing frequency in recent years [Markar 2010]. EVH reduces the development risk of infection, hematoma, seroma, and postoperative pain in the incision site [Perrault 2004;Yun 2005;Markar 2010;Accord 2011]. Early mobilization of patients reduces the length of hospital stay.…”

“…Early mobilization of patients reduces the length of hospital stay. EVH decreases the risk of trauma and maintains tissue perfusion by consequently reducing the wound-healing disturbances and complications and the need for a skin flap [Accord 2011]. Further manipulation and distension during the harvest of the saphenous vein with side branch ligation may cause endothelial damage [Cooper 1996].…”

“…After CABG surgery, wound healing disturbances such as infection, skin necrosis, hematoma, and neuropathy increase the length of hospital stay and hospital costs [Athanasiou 2003]. In order to reduce these complications, intermittent skin incision or endoscopic saphenous vein harvesting is of preference in reports [Perrault 2004;Yun 2005;Markar 2010;Accord 2011]. Long-term graft patency after CABG surgery is the most important factor affecting postoperative mortality and morbidity.…”

Midterm patency and risk factors for vein graft occlusion after endoscopic harvest

“…Popisují 1,5 % výskyt ranné infekce po odběru v průběhu hospitalizace. Ve 30denním sledování to bylo již 4,6 %, v 90denním 7,3 % [11]. Komplikace spojené s otevřenou metodou odběru, jako jsou infekce, dehiscence, bolestivost rány a nevyhovující kosmetické hledisko (důležité hlavně pro mladší pacienty), byly popsány i v jiných pracích [12][13][14].…”

Postoperative Complications and Patient’s Satisfaction after Harvesting of the Radial Artery for Coronary Artery Bypass

“…It became more popular mainly because of the esthetic results (less of a scar), which may improve patient's satisfaction. Still, there is no absolute consensus on this issue [3,4]. On the other hand, open technique is very comfortable, visualization of the conduit is perfect, and it is not time consuming in the skilful hands.…”