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Michels A, Baghdadwala M, Yacob M. How I do it: Endoscope-assisted in situ arterial reconstruction of the lower limb. J Vasc Surg Cases Innov Tech 2024; 10:101520. [PMID: 38989263 PMCID: PMC11234098 DOI: 10.1016/j.jvscit.2024.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 07/12/2024] Open
Abstract
Arterial reconstruction with the great saphenous vein is a frequently performed vascular surgery technique for revascularization of chronic limb threatening ischemia. Surgeon variations of the procedure are common and aim to balance patency, limb salvage, complications, hospital resources, and technical feasibility. We describe a minimally invasive revascularization option using endoscope assistance for in situ great saphenous vein-arterial bypass to treat infrainguinal occlusive disease. We highlight patient selection, operating room setup, instrument details, and procedure strategies that facilitate the use of this technique. The development and refinement of minimally invasive techniques for lower extremity arterial bypass are critical to reduce wound complications and improve limb salvage outcomes in patients.
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Affiliation(s)
- Alison Michels
- Division of Vascular Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mufaddal Baghdadwala
- Division of General Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Michael Yacob
- Division of Cardiovascular Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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Aridi HD, Sansone J, Ramchandani N, Gutwein AR, Rowe VL, Zheng X, Mao J, Goodney PP, Motaganahalli RL. Long-term outcomes of great saphenous vein harvest techniques for infrainguinal arterial bypass in a Medicare-matched registry database. J Vasc Surg 2024:S0741-5214(24)01215-1. [PMID: 38912996 DOI: 10.1016/j.jvs.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Long-term outcomes for harvesting techniques for great saphenous vein (GSV) and its impact on the outcomes of infrainguinal arterial bypass remains largely unknown. Endoscopic GSV harvesting (EVH) has emerged as a less invasive alternative to conventional open techniques. Using the Vascular Quality initiative Vascular Implant Surveillance & Interventional Outcomes Network (VQI-VISION) database, we compared the long-term outcomes of infrainguinal arterial bypass using open and endoscopic GSV harvest techniques. METHODS Patients who underwent infrainguinal GSV bypass between 2010 and 2019 were identified in the VQI-VISION Medicare linked database. Long-term outcomes of major/minor amputations, and reinterventions up to 5 years of follow-up were compared between continuous incisions, skip incision, and EVH, with continuous incisions being the reference group. Secondary outcomes included 30- and 90-day readmission, in addition to surgical site infections and patency rates at 6 months to 2 years postoperatively. Survival analysis using Kaplan-Meier curves and Cox regression hazard models were utilized to compare outcomes between groups. To adjust for multiple comparisons between the study groups, a P value of 2.5% was considered significant. RESULTS Among the 8915 patients included in the study, continuous and skip vein harvest techniques were used in 44.4% and 43.4% of cases each, whereas 12.3% underwent EVH. The utilization of EVH remained relatively stable at around 12% throughout the study period. Compared with GSV harvest using continuous incisions, EVH was associated with higher rates of reintervention at 1 year (46.5% vs 41.3%; adjusted hazard ratio [aHR], 1.22; 95% confidence interval [CI], 1.06-1.41; P = .01]. However, no significant difference was observed between EVH and continuous incisions, and between skip and continuous incisions in terms of long-term reintervention or major and minor amputations on adjusted analysis. Compared with continuous incision vein harvest, both EVH and skip incisions were associated with lower surgical site infection rates within the first 6 months post-bypass (aHR, 0.53; 95% CI, 0.35-0.82 and aHR, 0.68; 95% CI, 0.53-0.87, respectively). Loss of primary, primary-assisted, and secondary patency was higher after EVH compared with continuous incision vein harvest. Among surgeons performing EVH, comparable long-term outcomes were observed regardless of low (<4 cases/year), medium (4-7 cases/year), or high procedural volumes (>7 cases/year). CONCLUSIONS Despite higher 1-year reintervention rates, EVH for infrainguinal arterial bypass is not associated with a significant difference in long-term reintervention or amputation rates compared with other harvesting techniques. These outcomes are not influenced by procedural volumes for EVH technique.
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Affiliation(s)
- Hanaa D Aridi
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Jack Sansone
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Neal Ramchandani
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ashley R Gutwein
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Philip P Goodney
- Division of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Miralles M, Falcón M, Requejo L, Plana E, Medina P, Sánchez-Nevárez I, Clará A. "In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery. World J Surg 2023; 47:2888-2896. [PMID: 37432421 DOI: 10.1007/s00268-023-07107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery. METHODS Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded. RESULTS Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015). CONCLUSIONS Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.
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Affiliation(s)
- Manuel Miralles
- Department of Vascular Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Surgery, Facultad de Medicina, Universidad de Valencia (UV), Valencia, Spain
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | - Moisés Falcón
- Department of Vascular Surgery, Hospital de Manises, Valencia, Spain.
| | - Lucía Requejo
- Department of Vascular Surgery, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - Emma Plana
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | - Pilar Medina
- Hemostasia, Thrombosis, Arteriosclerosis and Vascular Biology, Instituto de Investigación Sanitaria IIS La Fe, Valencia, Spain
| | | | - Albert Clará
- Department of Vascular Surgery, Hospital Universitari del Mar, Barcelona, Spain
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Akingba AG, Chow WB, Rowe VL. Lower Extremity Bypass. Surg Clin North Am 2023; 103:767-778. [PMID: 37455036 DOI: 10.1016/j.suc.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The original description of the lower extremity bypass (LEB) provided surgeons with a reliable method of limb revascularization. The tenets of the operation have formed the foundation for the advances of surgical care. A careful evaluation of the chronic limb-threatening ischemia patient due to the numerous comorbid conditions is paramount to obtain the best possible outcomes. Use of all adjuncts including judicious target vessels control, completion imaging, and vein harvesting techniques to ensure optimal outcomes because a functioning LEB remains a key to successful limb salvage.
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Affiliation(s)
- Ajibola George Akingba
- DC VAMC, Uniformed Services University of Health Sciences, 50 Irving Street, Washington, DC 20422, USA
| | - Warren Bryan Chow
- Division of Vascular Surgery and Endovascular Therapy, David Geffen School of Medicine at UCLA, 200 Peter Morton Medical Building, Suite 526, Los Angeles, CA 90095, USA
| | - Vincent Lopez Rowe
- Division of Vascular Surgery and Endovascular Therapy, David Geffen School of Medicine at UCLA, 200 Peter Morton Medical Building, Suite 526, Los Angeles, CA 90095, USA.
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Gonçalves VA, Zimmermann DMV, Menezes FH. Correlations between ultrasound, tomographic, and intraoperative measurements of the great saphenous vein used as an arterial graft. J Vasc Bras 2023; 22:e20220121. [PMID: 37333754 PMCID: PMC10275644 DOI: 10.1590/1677-5449.202201212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/20/2023] [Indexed: 06/20/2023] Open
Abstract
Background The great saphenous vein is the major superficial vein of the lower limb, and also the most often used as arterial graft material for lower limb revascularization. Prior knowledge of the quality of the vein can guide choice of therapeutic strategy, avoiding surgery that is doomed to failure. Discrepancies between intraoperative findings of the quality of the great saphenous vein and imaging tests are also frequently observed. Objectives To evaluate the diameter of the great saphenous vein using two imaging methods (Duplex Ultrasound and Computed Tomography) and the gold-standard (intraoperative direct measurement of the vein), comparing the results. Methods Prospective, observational study of data obtained during routine medical procedures performed by the Vascular Surgery team. Results 41 patients were evaluated, with a 12-month follow-up. 27 (65.85%) were male and mean age was 65.37 years. 19 (46.34%) patients had femoropopliteal grafts and 22 (53.66%) had distal grafts. Preoperative saphenous vein internal diameters measured with the patient supine were on average 16.4% smaller on CT and 33.8% smaller on US than the external diameters measured after intraoperative hydrostatic dilatation. There were no statistical differences in measurements when sex, weight, and height were considered. Conclusions Saphenous vein diameters were underestimated by preoperative US and CT scans when compared to intraoperative measurements. Thus, in patients undergoing graft planning for revascularization, the choice of conduit should take this data into consideration, so that use of the saphenous vein is not ruled out unnecessarily during planning.
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Affiliation(s)
- Vinicius Adorno Gonçalves
- Universidade Estadual de Campinas - UNICAMP, Faculdade de Ciências Médicas, Hospital de Clínicas, São Paulo, SP, Brasil.
| | | | - Fábio Hüsemann Menezes
- Universidade Estadual de Campinas - UNICAMP, Faculdade de Ciências Médicas, Hospital de Clínicas, São Paulo, SP, Brasil.
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Biroš E, Staffa R, Novotný T, Krejčí M, Velecký L, Skotáková M. Long-Term Comparison of Endoscopic Versus Open Saphenous Vein Harvest for Femoral-to-Popliteal Artery Bypass. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Thomas JP, So KL, Turner JT, Malanowski AJ, Colvard BD. Optimal conduit choice for open lower extremity bypass in critical limb threatening ischemia. Semin Vasc Surg 2022; 35:172-179. [DOI: 10.1053/j.semvascsurg.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
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Non-reversed and Reversed Great Saphenous Vein Graft Configurations Offer Comparable Early Outcomes in Patients Undergoing Infrainguinal Bypass. Eur J Vasc Endovasc Surg 2022; 63:864-873. [DOI: 10.1016/j.ejvs.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022]
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Zhao AH, Kwok CHR, Jansen SJ. How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence. Ann Vasc Surg 2021; 78:336-361. [PMID: 34543711 DOI: 10.1016/j.avsg.2021.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND This review aims to identify and review the current evidence for preventing postoperative surgical site infections in abdominal aortic aneurysm surgery or infrainguinal arterial surgery. METHODS Extended literature review of clinical trials that examined the prevention of postoperative surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. Searches were conducted on Ovid MEDLINE (1950 - 13 March 2020) using key terms for vascular surgery, surgical site infections and specific preventative techniques. Articles were included if they discussed a relationship between a preventative technique and surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. The GRADE guidelines were used to assess the quality of evidence. RESULTS 21 techniques and 81 studies were included. Prophylactic antibiotics and negative pressure wound therapy have a high quality of evidence for the prevention of surgical site infections in abdominal aortic aneurysm or infrainguinal arterial surgery. A moderate quality evidence base was identified for gentamicin containing collagen implant (confined to high surgical site infection risk centers). Currently, there is a low or very low quality of evidence to suggest a reduction in the surgical site infection rate for combination therapy, glycaemic control, Methicillin-resistant Staphylococcus aureus screening and absorbable suture. Evidence suggests no beneficial effect for nutritional supplementation, chlorhexidine bath, hair removal therapy, Staphylococcus aureus nasal eradication, cyanoacrylate microsealant, silver grafts, rifampicin bonded grafts, triclosan coated suture and postoperative wound drains. Endoscopic saphenous vein harvest may reduce surgical site infection rate (very low quality of evidence) but may lower long-term patency. Autologous vein grafts may increase surgical site infections (very low quality of evidence) but may provide better long-term patency rates in above-knee infrainguinal bypass surgery. There was no identified evidence for perioperative normothermia, electrosurgical bipolar vessel sealer or Dermabond and Tegaderm for surgical site infection prevention in vascular surgery. CONCLUSIONS Prophylactic antibiotics and postoperative negative pressure wound therapy are effective in the prevention of postoperative surgical site infection in abdominal aortic aneurysm or infrainguinal arterial surgery. There exists a significant risk of bias in the literature for many preventative techniques and further studies are required to investigate the efficacy of gentamicin containing collagen implant, and specific combination therapies.
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Affiliation(s)
- Adam Hanting Zhao
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia; Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Western Australia, Nedlands, Western Australia, Australia.
| | - Chi Ho Ricky Kwok
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Western Australia, Nedlands, Western Australia, Australia
| | - Shirley Jane Jansen
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia; Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Western Australia, Nedlands, Western Australia, Australia; Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Nedlands, Western Australia, Australia
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Guo Q, Huang B, Zhao J. Systematic review and meta-analysis of saphenous vein harvesting and grafting for lower extremity arterial bypass. J Vasc Surg 2020; 73:1075-1086.e4. [PMID: 33091517 DOI: 10.1016/j.jvs.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In the present systematic review and meta-analysis, we compared the short- and long-term outcomes of different harvesting and grafting techniques in patients undergoing lower extremity arterial bypass. METHODS We searched multiple electronic databases (up to December 1, 2019) for comparative trials investigating different harvesting and bypass grafting techniques. RESULTS We identified a total of 37 studies for our review. Skip incision harvesting showed a similar high primary patency rate (Peto odds ratio [OR], 0.93; 95% confidence interval [CI], 0.83-1.04; P = .20) with continuous incision harvesting and comparable low wound complication rates (relative risk, 1.55; 95% CI, 0.91-2.66; P = .11) with endoscopic harvesting. In situ bypass grafting a long-term patency similar to that of reversed grafting (Peto OR, 1.01; 95% CI, 0.75-1.37; P = .93). However, for femoropopliteal bypass, the reversed bypass grafting group had significantly lower 2-year (Peto OR, 0.63; 95% CI, 0.52-0.78; P < .001) and 5-year (Peto OR, 0.70; 95% CI, 0.50-0.98; P = .04) failure rates compared with the in situ bypass grafting group. For infrapopliteal bypass, the in situ bypass grafting group had significantly lower 1-year (Peto OR, 1.54; 95% CI, 1.04-2.28; P = .03), 2-year (Peto OR, 1.52; 95% CI, 1.15-2.02; P = .003), and 3-year (Peto OR, 2.14; 95% CI, 1.13-4.05; P = .02) failure rates. CONCLUSIONS Skip incision harvesting can be considered the first-line harvesting strategy. For patients undergoing femoropopliteal bypass, reversed bypass grafting seems to result in better long-term patency. In contrast, for those undergoing infrapopliteal bypass, in situ bypass grafting resulted in superior long-term patency.
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Affiliation(s)
- Qiang Guo
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Zhang SZ, Wang GX, Zhou XT. The clinical application of microincision vein harvesting of the great saphenous vein in coronary artery bypass grafting. BMC Cardiovasc Disord 2020; 20:297. [PMID: 32552856 PMCID: PMC7301538 DOI: 10.1186/s12872-020-01555-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to summarize the clinical application of microincision vein harvesting (MVH) of the great saphenous vein in coronary artery bypass grafting (CABG). METHODS From July 2014 to October 2017, 160 patients underwent coronary artery bypass grafting. Among them, 80 patients received MVH of the great saphenous vein, and 80 received open venous harvesting (OVH). The results of the sampling operation, complications during hospitalization, and the long-term patency of the great saphenous vein were compared between the two groups. RESULTS All the patients in both groups received successful operations. The difference in the length of the veins obtained and the injury of the veins was not statistically significant (P > 0.05). The difference in the long-term patency rate of the graft vessels between the two groups was not statistically significant. The in-hospital mortality rate was the same in both groups. The MVH group had noticeable advantages over the OVH group in terms of the vein collection times, the incision length, and the complications experienced when performing the leg incisions (P < 0.01). The time relating to the patients' observed early out-of-bed activity was significantly longer in the MVH group. Furthermore, the patients' hospitalization length was significantly shorter in the MVH group compared to the OVH group (P < 0.05). The MVH group had significant advantages in pain score and patient satisfaction, and this difference was also statistically significant (P < 0.05). CONCLUSIONS The MVH procedure met the requirements of CABG in vein grafting. When compared with OVH, MVH can significantly reduce leg incision complications and improve patients' overall satisfaction with their hospital experience.
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Affiliation(s)
- Shao-Zhong Zhang
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
| | - Guo-Xiang Wang
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
| | - Xiao-Tong Zhou
- Department of thoracic-cardiovascular, Affiliated Hospital of Xuzhou Medical University, No. 58 of Hubei Street, Yongan District, Xuzhou, 221000 China
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Kronick M, Liem TK, Jung E, Abraham CZ, Moneta GL, Landry GJ. Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses. J Vasc Surg 2019; 70:1534-1542. [DOI: 10.1016/j.jvs.2019.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/19/2019] [Indexed: 10/26/2022]
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Mirza AK, Stauffer K, Fleming MD, De Martino R, Oderich G, Kalra M, Gloviczki P, Bower T. Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass. J Vasc Surg 2018; 67:1199-1206. [DOI: 10.1016/j.jvs.2017.08.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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Luckraz H, Cartwright C, Nagarajan K, Kaur P, Nevill A. Major adverse cardiac and cerebrovascular event and patients' quality of life after endoscopic vein harvesting as compared with open vein harvest (MAQEH): a pilot study. Open Heart 2018; 5:e000694. [PMID: 29344377 PMCID: PMC5761295 DOI: 10.1136/openhrt-2017-000694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/22/2017] [Accepted: 11/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background This is a prospective, comparative, pilot and follow-up (2-year postoperatively) study in patients undergoing coronary artery bypass graft surgery where the long saphenous vein was harvested either by the endoscopic vein harvest (EVH) technique or open vein harvest (OVH) technique. Quality of life (QOL) and major adverse cardiac and cerebrovascular events (MACCE) were assessed. Methods Alive patients who were initially part of a pilot study when EVH was introduced in our institution were included (n=48 EVH, n=49 OVH). Patients were sent a QOL questionnaire (SF12v2; 12-item medical outcomes study short form health survey version 2.0), and their cardiologist and general practitioner were contacted to assess MACCE. Results Median follow-up was 32 and 33 months, respectively. Three patients died (2 EVH, 1 OVH). Of the remaining 97 patients who were sent a questionnaire, 76% patients returned the form. More patients from the EVH group returned the QOL questionnaire (82% vs 71%). Time taken to return to normal daily activities was much shorter in EVH (median 6 (2–30) weeks) compared with OVH (median 9 (2–50) weeks) (P<0.05). QOL questionnaire revealed significant difference in physical score at follow-up: 45.3 (10.2) for EVH group and 40.7 (11.0) for OVH group (P<0.05). There was no difference in mental scores (46.9 (10.5) vs 49.2 (9.1), P=0.4). There were no significant differences in MACCEs including death between the two groups (12.2% vs 13.9%, P=0.5). Conclusion EVH patients returned to normal daily activities faster than OVH patients and experienced better physical QOL even after 2 years postoperatively with no increase in MACCE during follow-up.
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Affiliation(s)
- Heyman Luckraz
- Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK
| | - Carly Cartwright
- Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK
| | - Kumaresan Nagarajan
- Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK
| | - Prabhjeet Kaur
- Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK
| | - Alan Nevill
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
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