Endoscopic Versus “No-Touch” Saphenous Vein Harvesting for Coronary Artery Bypass Grafting

Abstract

The advantage in terms of wound infection, wound healing, and scarring has resulted in the recent adoption of endoscopic vein harvesting (EVH) as a standard of care for coronary artery bypass grafting in some centers. However, concerns regarding the quality of these grafts have been raised after recent evidence of decreased graft patency, increased reoperation rate, and myocardial infarct, problems that are associated with vascular trauma caused when using this technique. Simultaneously, an atraumatic, "no-touch" technique for harvesting the saphenous vein was developed producing grafts with improved patency comparable to the internal thoracic artery. However, wound complications remain a problem using this technique. This review outlines the need to consider the poor graft quality that may result from EVH and raises the question what is likely to be the "best practice principle" in saphenous vein harvesting?

Function and Viability of Vessels in Different Preservation Solutions - An Experimental Study on Human Great Saphenous Veins

“…Kopjar and Dashwood [26] focused on a critical aspect of the no-touch vein harvest that presents a major barrier to wide-spread adoption, which being the morbidity of the leg incision. Because all vein grafts in this study were harvested using the conventional technique, different solution-dependent results cannot be explained by different techniques.…”

Endoscopic or No-Touch Vein Harvesting for CABG: What is Best for the Patient?

“…While the benefits of EVH include reduced wound complications and improved cosmetic outcome, an inferior patency rate of EVH-SVs compared to those harvested by open vein harvesting (OVH) has been reported [ 3 ] (Figure 1). Previous guidance in the United Kingdom advised that EVH should only be used with special arrangements [ 4 ] .…”

“…While the incidence of wound complications in patients receiving no-touch SV is higher than in those receiving EVH grafts, they are similar to patients receiving OVH grafts and their performance is far superior, at ~90% vs. 50% long-term. Several studies have reported SV graft failure rates of up to 10% to 20% after 1 year and an additional 5% failure rate for each subsequent year with conventional OVH [ 3 , 12 - 14 ] . When performing OVH, the recent 2014 ESC/EACTS Guidelines on myocardial revascularization support the use of the notouch technique to reduce graft injury and improve patency [ 6 ] .…”

“…The reasons for this low take up rate are unclear, but may be associated with senior surgeons' resistance to change and/or unwillingness to "retrain", rather surprising given the rapid adoption of EVH to a present level of over 80% of all CABG in the USA [ 3 ] . EVH was recommended (Class I, Level A) to reduce wound-related complications, improve patient satisfaction, and decrease postoperative pain, hospital length of stay, and outpatient wound-management resources when compared with OVH [ 25 ] .…”

“…Early no-touch SV harvest site complications have been reported to range from 11% to 18% [ 25 ] , considerably higher when compared to EVH, although similar to conventional OVH [ 25 ] . Furthermore, the learning curve for EVH is longer [ 3 ] , and although it has been suggested that EVH is a cost effective method for harvesting the SV, the 2005 Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) concluded there was inadequate cost-effectiveness data to allow recommendations on the resource implications of OVH vs. EVH techniques [ 25 ] . Several recommendation statements and guidelines have emphasized the importance of experience when performing EVH [ 4 , 6 ] .…”