Download PDF
Thorac Cardiovasc Surg 2007; 55(7): 428-432
DOI: 10.1055/s-2007-965325
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

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

M. Šimek1 , P. Nemec1 , V. Bruk1 , M. Gwozdziewicz1 , I. Fluger1 , K. Langova2
  • 1Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
  • 2Institute of Medical Biophysics, University Faculty of Medicine, Olomouc, Czech Republic
Further Information

Publication History

received January 20, 2007

Publication Date:
28 September 2007 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: We sought to determine whether the postoperative and midterm outcomes of minimally invasive and endoscopic great saphenous vein harvesting are comparable. Methods: From February 2004 to September 2006, 120 patients underwent minimally invasive vein harvesting, and subsequently 150 patients had endoscopic vein harvesting for CABG. Patients were evaluated prospectively for wound-healing disturbances, residual leg oedema, pain intensity and saphenous neuropathy on the 7th postoperative day and after 3 months. Results: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, minimally invasive vein harvesting was associated with a significantly higher incidence of residual oedema (28 % vs. 13 %; p < 0.05), (19 % vs. 6 %; p < 0.001), pain (20 % vs. 9 %; p < 0.05), (10 % vs. 6 %; p < 0.05), and saphenous neuropathy (23 % vs. 7 %; p < 0.001) (14 % vs. 3 %; p < 0.001) during follow-up on the 7th postoperative day as well as 3 months after surgery, respectively. Mean harvesting time (40.6 ± 15.5 vs. 43.9 ± 10.2 min; p = 0.09), conversion rate (3 % vs. 2 %; p = 0.71), and injury per conduit (0.3 ± 0.2 vs. 0.3 ± 0.1; p = 0.91) were comparable for both groups. Conclusions: Endoscopic vein harvesting seems to be superior to minimally invasive vein harvesting in terms of a significant reduction of residual leg oedema, pain intensity and particularly saphenous neuropathy in the postoperative and midterm follow-up.

Key words

vein harvesting - coronary bypass surgery - minimally invasive - endoscopic - leg‐wound complications

References

  • 1 Wipke-Tevis D D, Storrs N A, Skov P, Carrieri-Kohlman V. Frequency, manifestation and correlates of impaired healing of saphenous vein harvest incisions.  Heart Lung. 1996;  25 108-116
    PubMedSearch in Google Scholar
  • 2 Paletta C E, Huang D B, Fiore A C, Swartz M T, Rilloraza F L, Gardner J E. Major leg wound complications after saphenous vein harvest for coronary revascularization.  Ann Thorac Surg. 2000;  70 492-497
    PubMedSearch in Google Scholar
  • 3 Garland R, Frizelle F A, Dobbs B R, Singh H. A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting.  Eur J Cardiothorac Surg. 2003;  23 950-955
    CrossrefPubMedSearch in Google Scholar
  • 4 Mountney J, Wilkinson G AL. Saphenous neuralgia after coronary artery bypass grafting.  Eur J Cardiothorac Surg. 1999;  16 440-443
    CrossrefPubMedSearch in Google Scholar
  • 5 Nair U R, Griffiths G, Lawson R A. Post-operative neuralgia in the leg after saphenous vein coronary artery bypass graft: a prospective study.  Thorax. 1988;  43 41-43
    PubMedSearch in Google Scholar
  • 6 Allen K B, Heimansohn D A, Robinson R J, Schier J J, Griffith G L, Fitzgerald E B. et al . Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting.  Heart Surg Forum. 2000;  4 325-330
    PubMedSearch in Google Scholar
  • 7 Athanasiou T, Aziz O, Al-Ruzzeh S, Philippidis P, Jones C, Purkayastha S. et al . Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis.  Eur J Cardiothorac Surg. 2004;  24 1-12
    PubMedSearch in Google Scholar
  • 8 Athanasiou T, Aziz O, Skapinakis P, Perunovic B, Hart J, Crossman M C. et al . Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvest.  Ann Thorac Surg. 2003;  76 2141-2146
    CrossrefPubMedSearch in Google Scholar
  • 9 Aziz O, Athanasiou T, Darzi A. Minimally invasive conduit harvesting: a systematic review.  Eur J Cardiothorac Surg. 2006;  29 324-333
    CrossrefPubMedSearch in Google Scholar
  • 10 Black E A, Campbell K, Channon K M, Ratnatunga C, Pillai R. Minimally invasive vein harvesting significantly reduces pain and wound morbidity.  Eur J Cardiothorac Surg. 2002;  22 381-386
    CrossrefPubMedSearch in Google Scholar
  • 11 Cisowski M, Wites M, Geber W, Gerber A, Bochanek A. Minimally invasive saphenous vein harvesting for coronary artery bypass grafting - comparison of three less invasive methods.  Med Sci Monitor. 2000;  6 735-739
    PubMedSearch in Google Scholar
  • 12 Cheng D, Allen K, Cohn W. et al . Endoscopic vascular harvest in coronary artery bypass grafting surgery: a meta-analysis of randomized trial and controlled trials.  Innovations. 2005;  1 61-74
    PubMedSearch in Google Scholar
  • 13 Fabricius A, Diegeler A, Doll N. et al . Minimally invasive saphenous vein harvesting techniques: morphology and postoperative outcome.  Ann Thorac Surg. 2000;  70 473-478
    CrossrefPubMedSearch in Google Scholar
  • 14 Griffith G L, Keith B A, Waller F B. et al . Endoscopic and traditional saphenous vein harvest: a histologic comparison.  Ann Thorac Surg. 2000;  69 520-523
    CrossrefPubMedSearch in Google Scholar
  • 15 Perrault L P, Jeanmart H, Bilodeau L. et al . Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: a prospective randomized trial.  J Thorac Cardiovasc Surg. 2004;  127 1402-1407
    CrossrefPubMedSearch in Google Scholar
  • 16 Davis Z, Garber D, Clark S. et al . Long-term patency of coronary graft with endoscopically harvested veins determined by contrast-enhanced electron beam computed tomography.  J Thorac Cardiovasc Surg. 2004;  127 823-828
    CrossrefPubMedSearch in Google Scholar
  • 17 Allen K B, Heimansohn D A, Robison R J. Influence of endoscopic versus traditional safenectomy on event-free survival: five-year follow-up a prospective randomized trial.  Heart Surg Forum. 2003;  6 143-145
    PubMedSearch in Google Scholar
  • 18 Cohn D J, Korver K F. Optimizing saphenous vein site selection using intraoperative venous duplex ultrasound scanning.  Ann Thorac Surg. 2005;  79 2013-2017
    CrossrefPubMedSearch in Google Scholar
  • 19 Šimek M, Bruk V, Němec P. Endoscopic saphenous vein harvesting for coronary artery bypass grafting. Postoperative and mid-term outcome in the group of 100 patients.  CorVasa. 2006;  48 427-432
    PubMedSearch in Google Scholar
  • 20 Šimek M, Němec P. Postoperative and mid-term wound disturbance outcomes of minimally invasive saphenous vein harvesting using the VEGA™ system.  Heart Vessels. 2007;  22 94-98
    CrossrefPubMedSearch in Google Scholar
  • 21 Allen K, Cheng D, Cohn W. et al . Endoscopic vascular harvest in coronary artery bypass grafting surgery: a consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005.  Innovations. 2005;  1 51-60
    CrossrefPubMedSearch in Google Scholar
  • 22 Burris N, Schwartz K, Brown J. et al . Incidence of residual clot strands in saphenous vein graft after endoscopic harvest.  Innovations. 2006;  1 323-327
    PubMedSearch in Google Scholar

MD Martin Šimek

Department of Cardiac Surgery
University Hospital and Palacky University Faculty of Medicine

I. P. Pavlova 6

77250 Olomouc

Czech Republic

Phone: + 42 05 88 44 23 44

Fax: + 42 05 88 44 23 37

Email: martin.simek@c-mail.cz