Open versus endoscopic saphenous vein harvesting: wound complications and vein quality

Crouch, John; O’Hair, Daniel; Keuler, James P; Barragry, T. P.; Werner, Paul H; Kleinman, Leonard H.

doi:10.1016/s0003-4975(99)00947-9

Cited by 61 publications

(71 citation statements)

References 8 publications

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“…This will increase hospital costs, as well as costs for outpatient visits with oral antibiotics, painful dressing changes and outpatient debridement. Perhaps more important, they affect the patient's quality of life by causing persistent pain, discomfort and difficulty with proper mobilization [9].…”

Section: Discussionmentioning

confidence: 99%

“…Vein harvesting has been reported even with a higher prevalence for wound complications and pain compared to median sternotomy [1]. When prospectively evaluated leg wound complications following longitudinal saphenectomy have resulted in 5-20% [8][9][10][11][12]. The subjective interpretation of wound complications may account for the wide variance reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic vein harvesting in coronary artery bypass surgery

et al. 2007

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Endoskopische Venenentnahme fü r aortokoronare BypassoperationenZusammenfassung. Grundlagen: Wundheilungsstö -rungen und Wundinfektionen am Bein nach Entnahme der Vena saphena magna (VSM) fü r aorto-coronare Bypassoperationen (CABG) stellen eine schwerwiegende Komplikation dar. Speziell bei Patienten mit Adipositas, Diabetes mellitus und peripheren Durchblutungsstörungen treten vermehrt tiefreichende Wundheilungsstö rungen mit starken Schmerzen auf.Methodik: Unser Ziel war es, die Anwendbarkeit und die Ergebnisse der endoskopischen Beinvenenentnahme zu untersuchen. Von Oktober 2002 bis November 2005 setzten wir bei 63 Patienten mit koronarer Herzerkrankung, die sich einer CABG-Operation unterziehen mussten, das VasoView + System der Fa. Guidant zur endoskopischen Entnahme der VSM ein. Wir untersuchten Entnahmezeit und Prä parationszeit der Vene, intraoperative Komplikationen und Konversion zur offenen Entnahmetechnik, Qualitä t der entnommen Vene und Anzahl an Reparaturnä hten, Flowwerte der eingesetzten Venengrafts und postoperative Wundkomplikationen.Ergebnisse: Die mittlere Entnahmezeit betrug 37,5 min (19-72 min). Aufgrund von Blutungen und Fettgewebsansammlungen im Prä parationskanal musste bei 4 Patienten zur offenen Entnahmetechnik konvertiert werden. Die Qualitä t der prä parierten Venen wurde mit einem Score von 1,4 auf einer Skala von 1-5 beurteilt. Die Seitenä ste wurden ligiert und geklippt, im Mittel mussten 1,4 Lö cher pro Vene von ausgerissenen Seitenä sten mit Prolene ü bernä ht werden. Bei einer Patientin war die Wand der endoskopisch entnommenen VSM zu dü nn und varikö s, sodass die Vene nicht als Bypassgraft verwendet werden konnte.Bei 17 Patienten (29%) wurde aus der endoskopisch prä parierten Vene ein Graft eingesetzt, bei 37 Patienten (64%) 2 Grafts und bei 4 Patienten (7%) 3 Grafts. Die Flowwerte der eingesetzten Grafts waren im Mittel 50 ml=min (10-159 ml=min). Postoperativ traten bei 22 Patienten (37%) umschriebene Hä matome entlang des Prä parationskanals auf, die bei Entlassung gä nzlich zurü ckgegangen waren. Wundheilungsstö rungen und Wundinfektionen am Bein traten bei keinem der Patienten auf.Schlussfolgerungen: Die Vorteile der endoskopischen Entnahmetechnik der VSM sind die geringere Traumatisierung des Beines und die schmerzfreie und schnellere Mobilisierbarkeit der Patienten. Die Prä parationszeit der Vene ist trotz ,,learning curve'' akzeptabel. Die Operationszeit wird nicht verzö gert. Die Visualisierung ist ausgezeichnet und die Handhabung des Systems ist schnell erlernbar. Die prä parierten Venen sind mit dieser Entnahmetechnik den konventionell offen entnommenen Venen ebenbü rtig, mit dem Vorteil der geringeren postoperativen Schmerzen und dem besseren kosmetischen Ergebnis. Die Konversionsrate zur offenen Technik ist gering (4 von 63). Postoperative Wundkomplikationen sind nicht zu erwarten.Schlü sselwö rter: Endoskopische Venenentnahme, aortokoronare Bypassoperationen.Summary. Background: Leg wound complications and infections after harvesting of the greater saphenous vein...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic vein harvesting in coronary artery bypass surgery

et al. 2007

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“…One of the most important closed technique is dissection of the greater saphenous vein by means of stripper (Meldrum-Hanna et al 1986). Endoscopic techniques diminished the need of cutenous incisions during harvesting (Rashid et al 1984;Crouch et al 1999;Newman and Lammle 1999).…”

Section: Methodsmentioning

confidence: 99%

The Risk Factors Affecting the Complications of Saphenous Vein Graft Harvesting in Aortocoronary Bypass Surgery

Kayacioglu

Çamur

Günay

et al. 2007

Tohoku J. Exp. Med.

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Problems of wound healing are commonly observed after coronary bypass grafting (CABG) operations. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complications after coronary artery bypass surgery. One hundred twenty six patients operated in the specified period were included in this prospective study. In an early period 3 patients were excluded because of their mortality. Twenty patients were female and 103 were male. Forty three patients underwent an open procedure with one incision (35%), 61 patients also underwent an open procedure but with multiple incisions (49%), and 19 patients underwent a closed procedure with stripper (16%). Complications related with leg incisions after surgery were investigated. Multiple incision technique has the longest (49.28 ± 14.7 cm; p < 0.001) total incision length (compare to single incision and stripper technique). As incision length increases, the incidence of drainage ( p < 0.01), pain score ( p < 0.05), hematoma ( p < 0.05) and diffuse ecchymosis ( p < 0.05) were increased. Drainage was seen more frequently in female ( p < 0.001) and diabetic patients ( p < 0.05). Sex ( p < 0.001) and incision length ( p < 0.05) have been found independent risk factors for drainage complication. Superficial infection ( p < 0.05), pain ( p < 0.05) and dehiscence ( p < 0.05) were significantly higher in female patients. As the incision length of the multiple incision technique became longer, the risk of drainage, pain, hematoma and diffuse ecchymosis were increased. The significantly increased risk for wound complications were also seen in female gender, diabetic and obese patients.saphenectomy; saphenous vein harvesting; coronary artery bypass surgery; wound; complication © 2007 Tohoku University Medical PressDespite the widespread use and superior patency of the internal mammarian artery and other arterial conduits, the saphenous vein continues to be the most commonly used conduit for coronary artery bypass graft surgery due to its length and lack of invasiveness. Open and also closed surgical techniques exist for the harvesting greater saphenous vein. However, problems of

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“…Major risk factors for the development of GSV harvestsite wound complications include female gender, obesity, diabetes mellitus, peripheral vascular disease, decreased left ventricular function, and perioperative hematocrit of less than 35% (Table 4) [50,56]. The use of the endoscopic vein-harvesting technique for the procurement of the GSV has been used to reduce the rate of leg-wound complications [57][58][59][60]. Alien et al compared the complication rates of endoscopic vein harvesting to the traditional method [57].…”

Section: Harvest-site Infections Following Cabgmentioning

confidence: 99%

“…A single steri-strip is all that is often required to approximate these incisions. The routine use of minimally invasive saphenous-vein harvesting can significantly 11 reduce the incidence of postoperative legwound complications [59,60].…”

Section: Harvest-site Infections Following Cabgmentioning

confidence: 99%

Noncardiac vascular complications of coronary bypass procedures: A review

2011

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The objective of this paper is to review the major vascular complications of coronary artery bypass grafting (CABG). We discuss the risk factors, causes, diagnoses, treatment, and prevention of the major complications. A Medline search was done of the English-language literature from 1966 to the present. Key words used included coronary artery bypass grafting, vascular complications, stroke, intra-aortic balloon pump, and acute mesenteric ischemia. Further references were obtained through cross-referencing the bibliography cited in each work. Only first-level evidence was used in the paper. The major vascular complications of CABG are postoperative stroke, acute mesenteric ischemia, acute leg ischemia secondary to intra-aortic balloon pump use, harvest-site wound infections, and deep venous thrombosis. These complications have significant effects on the morbidity and mortality, length of stay, and hospital costs associated with CABG surgery. As a general rule, high clinical suspicion and the administration of early diagnostic and therapeutic techniques for established complications will greatly reduce the morbidity and mortality associated with the respective complications.

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Open versus endoscopic saphenous vein harvesting: wound complications and vein quality

Cited by 61 publications

References 8 publications

Endoscopic vein harvesting in coronary artery bypass surgery

Endoscopic vein harvesting in coronary artery bypass surgery

The Risk Factors Affecting the Complications of Saphenous Vein Graft Harvesting in Aortocoronary Bypass Surgery

Noncardiac vascular complications of coronary bypass procedures: A review

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