Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Meta-Analysis of Randomized Trials and Controlled Trials

Evaluation of Postoperative Development of Saphenous Vein Graft Incision Site Infections in Patients Undergoing Isolated Coronary Artery Bypass Graft Surgery: A Single Center Experience

Objective: This study aimed to evaluate surgical site infection patients developing saphenous vein graft incision site infection after isolated coronary artery bypass graft surgery performed in the cardiovascular surgery clinic of our hospital in the last 12 years to reveal the causative microorganisms, risk factors, and clinical characteristics. Material and Methods: A total of 34 surgical site infection patients (23 females, 11 males; mean age 68.0±9.0 years; range 51-86 years) who underwent isolated coronary artery bypass graft surgery in the cardiovascular surgery clinic of our hospital between March 2009 and November 2020 and who postoperatively developed saphenous vein graft incision site infection were included in the study. The patients' demographic data, underlying diseases, and preoperative, intraoperative, and postoperative risk factors were analyzed retrospectively. Results: In all isolated coronary artery bypass graft surgeries performed over a period of about 12 years, the rate of saphenous vein graft incision site surgical site infection was found to be 0.8%. Of these, 23 (67.6%) were evaluated as superficial incisional surgical site infection and 11 (32.4%) as deep incisional surgical site infection. In the patients who developed surgical site infection, the parameters of age, female sex, obesity, diabetes mellitus, smoking, emergency surgery, use of more than 1 saphenous vein graft, prolonged operation, cardiopulmonary bypass, and aortic clamp durations, intraoperative blood transfusion, length of stay in the intensive care unit, use of inotropes, and total length of hospital stay were all found to be significant. The microorganisms in purulent discharge cultures consisted of Gram-negative bacteria in 18 (53%), Gram-positive bacteria in 12 (35.3%), and fungi in 1 (2.9%). No pathogenic microorganism growth was observed in 5 (14.7%) patients. In the patients with surgical site infection, coagulase-negative staphylococci (17.6%) and Escherichia coli (17.6%) were the most frequently isolated agents. Conclusion: Particular attention should be paid to surgical site infection in patients undergoing a cardiovascular surgery intervention. It should be noted that post coronary artery bypass graft surgery surgical site infection can be reduced by determining its risk factors, modifying surgical techniques, and postoperative close monitoring of patients. Follow-up and personal care are crucial after discharge and an empirical treatment approach should be determined when an infection occurs, taking into account that coagulase-negative staphylococci and E. coli were the two leading infectious agents in our hospital.

Endoscopic vein harvesting

Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009-2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.

Future Perspectives in Small-Diameter Vascular Graft Engineering

The increased demands of small-diameter vascular grafts (SDVGs) globally has forced the scientific society to explore alternative strategies utilizing the tissue engineering approaches. Cardiovascular disease (CVD) comprises one of the most lethal groups of non-communicable disorders worldwide. It has been estimated that in Europe, the healthcare cost for the administration of CVD is more than 169 billion €. Common manifestations involve the narrowing or occlusion of blood vessels. The replacement of damaged vessels with autologous grafts represents one of the applied therapeutic approaches in CVD. However, significant drawbacks are accompanying the above procedure; therefore, the exploration of alternative vessel sources must be performed. Engineered SDVGs can be produced through the utilization of non-degradable/degradable and naturally derived materials. Decellularized vessels represent also an alternative valuable source for the development of SDVGs. In this review, a great number of SDVG engineering approaches will be highlighted. Importantly, the state-of-the-art methodologies, which are currently employed, will be comprehensively presented. A discussion summarizing the key marks and the future perspectives of SDVG engineering will be included in this review. Taking into consideration the increased number of patients with CVD, SDVG engineering may assist significantly in cardiovascular reconstructive surgery and, therefore, the overall improvement of patients' life.

Risk factors for limb surgical site infection following coronary artery bypass graft using open great saphenous vein harvesting: a retrospective cohort study

OBJECTIVES

Our goal was to define risk factors for limb (leg) surgical site infections (SSIs) following coronary artery bypass grafting (CABG) with open saphenous vein grafting and to estimate their consequences for patients.

METHODS

We performed a retrospective cohort study in a primary and tertiary hospital in Israel that included all adult patients undergoing CABG with open saphenous vein harvesting (November 2014-August 2016). Patients were followed perioperatively from admission until 90 days postoperatively, including post-discharge follow-up. Operative data were collected prospectively. We analysed risk factors for leg SSIs using univariate and multivariate methods.

RESULTS

Thirty-six of 351 (10.3%) patients developed leg SSI. Median time to detection was 14 days (interquartile range 11-24) and 25/36 (69.4%) patients were diagnosed after discharge. Independent risk factors for SSI included female sex [odds ratio (OR) 4.08, 95% confidence interval (CI) 1.79-9.28], body mass index >30 (OR 2.12, 95% CI 1.01-4.48), peripheral vascular disease (OR 3.33, 95% CI 1.48-7.49) and use of more than 1 saphenous vein graft (OR 2.08, 95% CI 0.88-4.96). Infected patients had longer hospitalizations after surgery [7 days (5-12) vs 6 days (5-7), P = 0.002], higher antibiotic consumption (P = 0.002) and higher readmission rates of 24/36 (66.7%) vs 59/262 (22.5%) (P < 0.001) than non-infected controls.

CONCLUSIONS

Leg SSIs following coronary artery bypass surgery are common and associated with morbidity. We suggest reconsidering open saphenous vein harvesting in obese female patients with peripheral vascular disease.

VENOUS CONDUITS IN CORONARY SURGERY: OLD PROBLEMS — NEW SOLUTIONS

The introduction of autovenous coronary artery bypass grafting (CABG) marked the era of surgical revascularization in patients with coronary artery disease. It provided effective treatment for angina and significantly improved the long-term prognosis. Venous transplants today remain the most popular conduits in coronary surgery due to their availability, ease of harvesting, and the absence of length restrictions. Despite the advantages of autovenous CABG, the main disadvantage is the high incidence of venous graft failure, which represents an important and unresolved problem in cardiac and cardiovascular surgery. On the other hand, the traditional allocation of a large saphenous vein implies the dissection of soft tissues throughout the length of the isolated conduit. Traumatic dissection causes a long-lasting persistent pain syndrome after surgery, frequent abnormalities in  skin sensitivity, and a high incidence of wound complications in the lower extremities. These complications lengthen the period of rehabilitation of patients and worsen the quality of life. There is an approach of isolating the vein in a block with surrounding tissues to optimize the long-term functioning of the venous shunt, however, this technique is even more traumatic than the traditional method, and therefore its use is limited in practice. On the other hand, the introduction of minimally invasive methods of isolation allowed to reduce the incidence of wound complications and to improve the cosmetic result, but there is no convincing data regarding the effect on the consistency of shunts in the long-term postoperative period. The problems associated with the use of venous conduits in CABG are multifaceted, and their solutions are necessary to improve the effectiveness of surgical revascularization.

Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis

Background

Saphenous vein grafts (SVG) are a commonly used conduit for coronary artery bypass graft (CABG) surgery and can be harvested by either an open or endoscopic technique. Our goal was to evaluate long-term angiographic and clinical outcomes of open compared to endoscopic SVG harvest for CABG.

Methods

Electronic search was performed to identify all studies in the English literature that compared open and endoscopic SVG harvesting for CABG with at least one year of follow-up. The primary outcome was graft patency. Secondary outcomes included perioperative morbidity and mortality.

Results

Of 3,255 articles identified, a total of 11 studies were included for analysis. Of 18,131 patients, 10,873 (60%) patients underwent open SVG harvest and 7,258 (40%) patients underwent endoscopic SVG harvest. The mean age of patients was 65 years and 87% were male. The overall mean follow-up period was 2.6 years. During follow-up, patients who underwent open SVG harvest had superior graft patency per graft [open 82.3% vs. endoscopic 75.1%; OR: 0.61 (95% CI, 0.43-0.87); P=0.01], but higher rates of overall wound complications in the immediate post-operative period [open 3.3% vs. endoscopic 1.1%; OR: 0.02 (95% CI, 0.01-0.06); P<0.001]. Patients who underwent open SVG harvest had higher postoperative 30-day mortality [open 3.4% vs. endoscopic 2.1%; OR: 0.59 (95% CI, 0.37-0.94); P=0.03], but no significant difference in overall mortality [open 4.9% vs. endoscopic 4.9%; OR: 0.34 (95% CI, 0.50-1.27); P=0.34].

Conclusions

Patients who underwent an open SVG harvest technique had improved graft patency and comparable overall mortality to endoscopic SVG harvest at average follow-up time of 2.6 years. Patients with open SVG harvest had higher rates of early wound complications and postoperative 30-day mortality, however, there was no difference in overall mortality.

Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery

Objective

The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials.

Methods

All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,1,2 in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis. Based on the resultant, 76 studies (23 randomized controlled trials and 53 nonrandomized controlled trials) on 281,459 patients analyzed, consensus statements, and recommendations were generated comparing the risks and benefits of endoscopic versus open conduit harvesting for patients undergoing coronary artery bypass grafting.

Results

Compared with open vein harvest, it is reasonable to perform endoscopic vein harvest of saphenous vein to reduce wound-related complications, postoperative length of stay, and outpatient wound management resources and to increase patient satisfaction (class I, level A). Based on the quality of the conduit and major adverse cardiac events as well as 6-month angiographic patency, endoscopic vein harvest was noninferior to open harvest. It is reasonable to perform endoscopic radial artery harvest to reduce wound-related complication and to increase patient satisfaction (class I, level B-R and B-NR, respectively) with reduction in major adverse cardiac events and noninferior patency rate at 1 and 3 to 5 years (class III, level B-R).

Conclusions

Based on the consensus statements, the consensus panel recommends (class I, level B) that endoscopic saphenous vein and radial artery harvesting should be the standard of care for patients who require these conduits for coronary revascularization.

Hospital-Based HTA and Know4Go at MEDICI in London, Ontario, Canada

The majority of healthcare in Canada is universally provided and publicly funded through the provincial government.

Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad

INTRODUCTION

Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes.

METHODS

This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis.

RESULTS

The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques.

CONCLUSION

EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH.

Endoscopic harvesting device type and outcomes in patients undergoing coronary artery bypass surgery

OBJECTIVE

To evaluate angiographic and clinical outcomes associated with open and closed dissection tunnel endoscopic vein harvesting (EVH) devices.

BACKGROUND

A previous PREVENT-IV (PRoject of Ex-vivo Vein graft ENgineering via Transfection IV) analysis reported that EVH for coronary artery bypass graft surgery was associated with worse outcomes than with traditional vein harvesting; however, outcomes by EVH device type were not available.

METHODS

Using data from the PREVENT-IV trial, we compared 1549 patients from 75 surgical sites who underwent EVH with open (n = 390) or closed (n = 1159) harvest tunnel devices. Outcomes included the incidence of vein graft failure at 12 to 18 months and a composite of death, myocardial infarction, and revascularization through 5 years.

RESULTS

Among patients undergoing open and closed tunnel EVH, no difference in the per-patient incidence of vein graft failure (43.8% vs 47.1%; adjusted odds ratio, 0.91; 95% confidence interval, 0.53-1.55; P = 0.724) or per-graft incidence of vein graft failure (25.5% vs 25.9%; adjusted odds ratio, 0.96; 95% confidence interval, 0.59-1.55; P = 0.847) was observed. At 5 years, no difference was observed in the primary composite clinical outcome between patients who underwent open and closed system EVH (21.5% vs 23.9%; adjusted hazard ratio, 0.85; 95% confidence interval, 0.66-1.10; P = 0.221).

CONCLUSIONS

No differences in angiographic or clinical outcomes were observed among patients who underwent open versus closed tunnel endoscopic harvesting for coronary bypass surgery. These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device.

Endoscopic vein harvesting: technique, outcomes, concerns & controversies

The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short- and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH.

Prevention of vessel desiccation and maintenance of normal morphology during endovascular harvesting using humidified warmed gas

Dry, cold CO₂ gas was found to cause tissue damage during endovascular harvest. The use of warmed, humidified CO₂ gas appeared to maintain vessel morphology and integrity during endovascular harvest by preventing tissue desiccation.

Background and Objectives:

Endoscopic vessel harvesting (EVH) traditionally uses carbon dioxide (CO₂) gas for insufflation. The CO₂ based on government regulations is bone dry and room temperature. All previous EVH studies use this type of unconditioned gas. It is hypothesized that by changing the quality of CO₂ gas differences may occur that are attributable to dry gas versus wet gas exposure.

Methods:

A comparison of the effect(s) of traditional dry CO₂ gas compared to humidified exposure was done using a porcine model and evaluated in a double-blind randomized controlled fashion.

Results:

Vessels exposed to traditional dry cold gas had morphologic and structural changes noted on histologic evaluation. This included desiccation changes of the tunica adventitia desiccation and tunica media collagen and elastin. Vessels exposed to dry gas showed 10% to 12% contraction and constriction with tortuous changes to the intima and endothelial lining that were progressive with increasing volumes of gas exposure. No desiccation or morphologic changes were seen with humidified warmed gas produced using the VesselGuardian.

Conclusions:

Traditional dry cold CO₂ caused vascular tissue damage extending from the adventitia to intima, changing the vessel in morphologic and structural configuration. With the VesselGuardian humidified warmed, gas maintained vessel morphology and integrity by preventing desiccation. Changing the quality of CO₂ from dry and cold to wet and warm may offer clinical utility for a better quality conduit for coronary artery bypass graft procedures.

Absorption of carbon dioxide during endoscopic vein harvest

OBJECTIVES

Carbon dioxide (CO(2)) insufflation was used by some devices for endoscopic vein harvest to create a subcutaneous tunnel and facilitate the vein harvest. In the literature, some cases of CO(2) micro- and macro-embolisms or hypercarbia during this procedure are described. The purpose of this study was to evaluate if the use of an open CO(2) system rather than a sealed system might be associated with different CO(2) absorption during the procedure.

METHODS

Patients were randomized into two groups: those patients in the first group were submitted to endoscopic vein harvest using a sealed CO(2) insufflation; in the second group, the harvest was undertaken with an open CO(2) insufflation. Partial pressure of CO(2) in the arterial blood (PaCO(2)) and end-tidal CO(2) (ETCO(2)) was recorded following anaesthesia induction and before the endoscopic procedure (T0), every 10 min during the endoscopic step (T1) and end after 10 min from the CO(2) insufflation termination (T2).

RESULTS

A total of 60 patients were enrolled. PaCO(2) increased significantly between T0, T1 and T2 in both groups (P = 0.0001) during the endoscopic harvest, but the PaCO(2) level was significantly higher in the group that used the sealed system (44.5 ± 7.9 vs 39.7 ± 7.9 mmHg) at the end of the procedure (P = 0.01). No significant differences between end-tidal CO(2) measured at the same intervals between groups were detected.

CONCLUSIONS

There was a constant increase in the blood gas concentration compared with the basal pre-procedure values. Sealed systems were associated with a significantly higher CO(2) concentration at the end of the procedure compared with the open ones.

Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

Background

In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature.

Methods/Design

Endoscopic Saphenous harvesting with an Open CO₂ System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre.

Discussion

The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short and long-term outcomes and vein-graft patency after endoscopic open CO₂ harvesting system versus conventional vein harvesting.

The expected results are of high clinical relevance and will show the safety/efficacy or non-inferiority of one treatment approach in terms of vein harvesting for coronary artery bypass grafting surgery.

Trial registration

www.clinicalTrials.gov NCT01121341.

Optical coherence tomography imaging as a quality assurance tool for evaluating endoscopic harvest of the radial artery

BACKGROUND

Concerns about intimal disruption and spasm have limited enthusiasm for endoscopic radial artery harvest (ERAH), although the risk of these problems after this procedure remains uncertain. Radial artery conduits were screened intraoperatively before and after ERAH vs open harvest using catheter-based high-resolution optical coherence tomography (OCT) imaging.

METHODS

Twenty-four cadavers and 60 coronary artery bypass graft (CABG) patients scheduled to receive a RA graft underwent OCT imaging before (in situ) and after (ex vivo) open harvest or ERAH. Spasm was quantified by the percentage change in luminal volume between images. Intimal disruption was classified as minor or severe depending on whether the defect was confined to branch ostia or involved the luminal surface. Histology was used to confirm OCT findings.

RESULTS

Luminal volume significantly declined after harvest in all RAs from CABG patients, but there was no difference between groups: -43% +/- 29% vs -35% +/- 38% change after ERAH (n = 21) vs open harvest (n = 39; p = 0.342). Significantly more intimal injury was noted after ERAH vs open harvest (34/41 vs 9/43, intimal tears/total evaluated RAs, p < 0.0001). Most intimal injury was minor: only 2 tears involved the luminal surface of the RA (both after ERAH). Serial imaging in cadavers revealed that 86% of ostial tears occur in ERAH during the initial blunt dissection step using the endoscope.

CONCLUSIONS

Although branch injury is a pitfall of ERAH, OCT imaging documented that the quality of RA procured is acceptable and comparable with open harvest. Catheter-based OCT provides an important quality assurance tool for RA harvest.

Strategies to reduce intraluminal clot formation in endoscopically harvested saphenous veins

OBJECTIVE

Residual clot strands within the excised saphenous vein are an increasingly recognized sequela of endoscopic vein harvest. We hypothesized that endoscopic visualization facilitated by sealed carbon dioxide insufflation causes stagnation of blood within the saphenous vein. In the absence of prior heparin administration, this stasis provokes clot formation.

METHODS

Forty consecutive patients having coronary artery bypass grafting underwent endoscopic vein harvest using sealed (Guidant VasoView, n = 30; Guidant Corp, Minneapolis, Minn) or open (Datascope ClearGlide, n = 10; Datascope Corp, Montvale, NJ) carbon dioxide insufflation followed by ex vivo assessment of intraluminal saphenous vein clot via optical coherence tomography. In the sealed carbon dioxide insufflation groups, clot formation was compared with (preheparinized, n = 20) and without (control, n = 10) heparin administration before endoscopic vein harvest, either at a fixed dose or titrated to an activated clotting time greater than 300 seconds. Risk factors for clot formation were assessed.

RESULTS

Residual saphenous vein clot was a universal finding in control veins (sealed carbon dioxide insufflation endoscopic vein harvest without preheparinization). At either dose used, heparin given before endoscopic vein harvest significantly decreased saphenous vein clot burden. A similar reduction in clot was observed when using open carbon dioxide insufflation endoscopic vein harvest without preheparinization. Intraoperative blood loss and blood product requirements were similar in all groups. Patient age and preoperative maximum amplitude of the thrombelastography tracing showed a linear correlation with saphenous vein clot volume.

CONCLUSION

By enabling the quantification of this issue as never before possible, optical coherence tomography screening revealed that intraluminal saphenous vein clot is frequently found after endoscopic vein harvest. Systemic heparinization before harvest or an open carbon dioxide endoscopic vein harvest system are benign changes in practice that can significantly lessen this complication.

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

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.