“Extended length” endoscopic harvest of the great saphenous vein for coronary artery bypass grafting

Abstract

Introduction: The endoscopically harvested vein from thigh usually falls short by half to one length in patients requiring multiple conduits. Increased risk of complications precludes routine endoscopic vein harvest from the leg and an extra incision for open technique is often required thereby nullifying the sole purpose of the former. We employed the endoscope to harvest this extra length of vein from the upper half of the leg with little or no extra risk. Methods: From January 2006 to September 2006 we endoscopically harvested the vein in thigh as well as the leg using the same entry point incision over the medial epicondyle in 40 cases. The only exclusion criterion for the study was a superficial location and subcutaneous visibility of the vein in the leg. We made 3 incisions in each patient of average size 2. 5 cm. Results: Five patients required conversion to the open technique. The average harvest time was 59 minutes. Average length of the conduit was 48 cms. Complications included 1 minor wound infection, 1 case of superficial wound dehiscence, 1 haematoma requiring aspiration and minor erythema at the incision site in 2 patients. Most common complication observed was ecchymosis in 6 patients (5 thigh; 3 leg). None of the patient developed lymphoedema and none required re-hospitalization for vein harvest related wound complications. Conclusion: "Extended endoscopic vein harvest" and avoidance of the open incision was possible in most patients with no additional risk and that the procedure could be routinely employed in patients requiring multiple conduits. (Ind J Thorac Cardiovasc Surg, 2007; 23: 125-127)

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

“…The results using this technique are superior to OVH or combined (EVH in thigh and OVH in leg) techniques. By avoiding wound complications minimally invasive techniques for vein harvest may reduce postoperative morbidity, and hospital stay [4] . Learning curve of EVH is growing; we started with 70min.…”

“…Patients undergoing CABG experience wound complications (3%-30%) related to OVH technique. It requires an extended incision and the associated complications often prove troublesome in the recuperative phase of CABG [4] .…”

“…The endoscope could be negotiated through the same entry wound at knee level to harvest an additional length from the leg without conversion to open. The use of EVH method reduces the invasiveness of OVH method and its morbidity [4] .…”

Endoscopic vein harvesting

“…The full saphenectomy wound is the longest used in any surgery, with harvest lengths up to 85cm (6). This can confer significant morbidity to patients, affecting a quarter to a third of patients who have an open surgical harvest and adding substantially to the cost of wound care in the post-operative period (7,8).…”

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

“…OVH technique has an incidence of 3% to 30% wound complication. It may necessitate extending the incision above the knee with more complications [Mandiye 2007]. Since 1996, the first clinical report of EVH was published; it increased in popularity to become the preferred method of SVG harvesting [Zenati 2011].…”