Endoscopic vein harvesting

Abstract

Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009-2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.

Vein Morphology in Endoscopic Vein Harvesting: 15-Year Outcomes

“…16 A meta-analysis by Akowuah et al concluded that, in experienced hands, there was no increase in MACE or mortality in midterm and long-term follow-up. 17 The purpose of this study was to delineate the impact of vein morphology on the 15-year outcomes of EVH. This study was designed only to evaluate survival and MACE outcomes and not graft patency.…”

“…16 A meta-analysis by Akowuah et al concluded that, in experienced hands, there was no increase in MACE or mortality in midterm and long-term follow-up. 17…”

Learning process and results in endoscopic saphenous vein harvesting technique

“…Although SVG preparation in CABG is an important step of the surgery, it is traditionally prepared with long incisions or bridged incisions [15]. When performed with the conventional surgical method, the incision in each leg can be up to 85 cm long, making it one of the longest incisions of any routine surgery [16]. Various complications can be seen in the incision area after SVG preparation, especially in patients with risk factors such as obesity (BMI> 30), diabetes mellitus, peripheral vascular disease and female patient.…”

Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery

“…Endoscopic vein harvesting (EVH) consists of the dissection and the harvest of the graft, videoscopically guided, through small skin incisions. This method is thought to reduce the rate of wound-related complications [ 61 ]. Despite the potential benefit of this technique, in 2009, a subgroup analysis of the PREVENT trial demonstrated that EVH was associated with a significantly higher rate of failure compared to open harvesting at a 12- to 18-month follow-up.…”