Postoperative and mid-term wound disturbance outcomes of minimally invasive saphenous vein harvest using the VEGA system

Abstract

Great saphenous vein harvest is associated with a significant risk of impaired wound healing. The purpose of this study was to determine efficacy of one system designed for minimally invasive vein harvest (MIVH) and to assess postoperative and mid-term wound-healing disturbances. From February 2004 to June 2005, great saphenous harvest for coronary artery bypass grafting (CABG) was performed in a group of 120 consecutive patients employing the VEGA system (B/Braun-Aesculap, Tuttlingen, Germany). Patients were evaluated on 7th postoperative day, at the 3-month and 1-year follow-up for wound healing disturbances, residual leg edema, and saphenous neuropathy. The mean age was 67.3 years, male patients dominated (70%), and the leading procedure was CABG (83%). The mean number of harvested venous grafts was 1.9 +/- 1.2 and the mean number of skin incisions was 3.7 +/- 2.2. The mean total vein harvesting time was 40.2 +/- 16.8 minutes. Satisfactory healing was achieved in 98% patients on 7th postoperative day and at the 3-month follow-up all wounds were completely healed. Saphenous neuralgia remained a significant cause of morbidity, although its incidence decreased from 25% presented on 7th postoperative day to 8% presented at 1-year follow-up. Likewise, the incidence of leg edema decreased from 34% on the 7th postoperative day to 7% at 1-year follow-up. Minimally invasive vein harvest is a safe method associated with a significant reduction of wound disturbances. The VEGA system appears to be suitable and effective equipment for MIVH. Nevertheless, residual edema and mainly saphenous neuropathy represent a relatively frequent cause of patient morbidity at the postoperative and mid-term follow-up.

Endoscopic saphenous vein harvesting for coronary artery bypass grafting. Postoperative and mid-term outcome in a group of 100 patients

“…(2,7,21) Nicménû u fiady nemocn˘ch i pfii této technice odbûru setrvávají neurologické komplikace ve stfiednûdobém a dlouhodobém sledovaní. (13,14) Je zcela evidentní, Ïe v˘skyt neurologick˘ch komplikací v inervaãní zónû nervus saphenus úzce souvisí s disekcí v oblasti distálního bérce, kde vztah nervus saphenus a VSM je velmi blízk˘; i velmi ‰etrná odbûrová technika zcela nezabrání urãitému stupni traumatizace tohoto senzitivního nervu. (4,6,14) Dobfie je znám i vztah mezi v˘skytem neurologick˘ch komplikací a technikou uzávûru incize.…”

“…V na‰em souboru vedl EVH ke 3-5násobnému sní-Ïení v˘skytu ran˘ch a neurologick˘ch komplikací, reziduálních otokÛ a bolesti ve srovnání s mininvazivním odbûrem VSM. (13,23,24) U EVH byl zaznamenán pouze mírnû vy‰‰í v˘skyt lokálních ran˘ch hemato-mÛ v prÛbûhu odbûrového kanálu, které v‰ak nebyly spojeny s dal‰ími komplikacemi. Dále je i z na‰eho souboru zfiejmé, Ïe EVH lze povaÏovat za metodu volby odbûru VSM ve skupinû nemocn˘ch s pfiítomností rizikov˘ch faktorÛ rozvoje ran˘ch komplikací.…”

Postoperative and Midterm Outcomes of Minimally Invasive and Endoscopic Great Saphenous Vein Harvesting for Coronary Artery Bypass Grafting - A Prospective Analysis

“…The macroscopic appearance of harvested veins was equal in both groups, with a similar number of vein injuries requiring a venous repair stitch. Furthermore, EVH did not lead to a more frequent employment of sequential grafting, because the procured length of conduits was significantly longer in this group [19,20]. In our experience, the learning curve was slightly longer in the EVH group; however, it did not exceed 20 cases and both techniques were quickly mastered [19,20].…”

“…The impact on saphenous neuropathy was undoubtedly associated with the fact that the majority of EVH procedures are performed at the thigh area, where the anatomic relationship between GSV and saphenous nerve is not so imminent. Moreover, recent experience has showed that EVH is capable of reducing the incidence of saphenous neuropathy if EVH has been carried out from the calf area [20]. The macroscopic appearance of harvested veins was equal in both groups, with a similar number of vein injuries requiring a venous repair stitch.…”

“…The whole harvesting procedure was carried out using closed CO 2 transit time flow insufflation. Both harvesting techniques have been described in detail previously [19,20].…”