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Abstract

Purpose:

To compare the operative variables, complications, and potential benefits of endoscopic saphenous vein harvesting (ESVH) with traditional open vein retrieval for coronary artery bypass grafting (CABG).

Methods:

Data were collected retrospectively on 212 consecutive CABG patients from whom saphenous veins were harvested by one surgeon using either an open saphenous vein harvesting (OSVH) technique (n = 135) or ESVH (n = 77) performed with the ENDOSAPH Vein Harvest System. Fifty-three patients underwent a purely endoscopic procedure, whereas 24 patients had either a combined endo-open procedure (n = 13) or were converted to an open technique (n = 11) because of equipment failure or adverse anatomical characteristics. Harvest time was measured from initial leg incision to aortic cross-clamping. Leg wound complications were evaluated on the basis of progressive severity.

Results:

Harvest and procedural times were longer for the ESVH group (111 and 313 minutes, respectively) than for the OSVH patients (63 and 252 minutes, respectively, p < 0.001). Mean length of stay was not appreciably different: 11.7 ± 6.2 days (range 3–52) for the OSVH group, compared with 11.0 ± 6.0 days (range 3–41) for the ESVH patients (p = 0.40). Fewer complications occurred in the ESVH group when a purely endoscopic procedure was performed (17% versus 35% for OSVH, p = 0.012). Infection occurred in 1 OSVH and in 4 ESVH patients, but 3 of the endoscopic patients had a combined procedure. Bivariate correlational analysis showed that an increased number of incisions (r = 0.29, p < 0.01), obesity (r = 0.18, p < 0.01), and short stature (r = −0.16, p < 0.05) were associated with leg wound complications, but hierarchial stepwise regression analysis determined only short stature to be a predictive variable (β = 0.17, R² = 0.03).

Conclusions:

Despite increased operating time, ESVH results in fewer complications when a purely endoscopic procedure is performed.

Keywords

saphenous vein graft complications coronary artery bypass grafting minimally invasive techniques

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References

Grondin

Campeau

Lesperance

. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation. 1984;70(suppl I):208–212.

Lytle

Loop

Cosgrove

. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89:248–258.

Grondin

Campeau

Thornton

. Coronary artery bypass grafting with saphenous vein. Circulation. 1989;79(suppl I):24–29.

van Son

JAM

Smedts

Vincent

. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg. 1990;99:703–707.

Morris

Butler

Samuels

. Minimally invasive saphenous vein harvesting. Ann Thorac Surg. 1998;66:1026–1028.

Davis

Jacobs

Zhang

. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiovasc Surg. 1998;116:228–235.

Allen

Griffith

Heimansohn

. Endoscopic versus traditional saphenous vein harvesting: a prospective randomized trial. Ann Thorac Surg. 1998;66:26–32.

Puskas

Wright

Miller

. A randomized trial of endoscopic versus open saphenous vein harvest in coronary bypass surgery. Ann Thorac Surg. 1999;68:1509–1512.

Crouch

O'Hair

Keuler

. Open versus endoscopic vein harvesting: wound complications and vein quality. Ann Thorac Surg. 1999;68:1513–1516.

10.

Hayward

Hey

Newman

. Endoscopic versus open saphenous vein harvest: the effect on postoperative outcomes. Ann Thorac Surg. 1999;68:2107–2111.

11.

Kan

Luo

Tang

. Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients. J Card Surg. 1999;14:157–162.

12.

Carrizo

Livesay

Luy

. Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting. Tex Heart Inst J. 1999;26:120–123.

13.

Lutz

Schlensak

Lutter

. Minimal-invasive, video-assisted vein harvesting for cardiac and vascular surgical procedures. Eur J Cardiovasc Surg. 1997;12:519–521.

14.

Cable

Dearani

. Endoscopic saphenous vein harvesting: minimally invasive video-assisted saphenectomy. Ann Thorac Surg. 1997;64:1183–1185.

15.

Wipke-Tevis

Stotts

Skov

. Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions. Heart Lung. 1996;25:108–116.

16.

Shah

Chang

Leopold

. The anatomy of the greater saphenous venous system. J Vasc Surg. 1986;3:273–281.

17.

Delaria

Hunter

Goldin

. Leg wound complications associated with coronary revascularization. J Thorac Cardiovasc Surg. 1981;81:403–407.

18.

Utley

Thomason

Wallace

. Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg. 1989;98:147–149.

A Retrospective Comparative Study of Open and Endoscopic Saphenous Vein Harvesting