Leg Wound Complications: A Comparison Between Endoscopic and Open Saphenous Vein Harvesting Techniques

Background: The most common conduit for coronary artery bypass graft (CABG) surgery is saphenous vein graft (SVG). There are two techniques for SVG harvesting: open and endoscopic. Our aim is to evaluate clinical results of endoscopic versus open SVG harvesting. Nowadays, endoscopic vein harvesting (EVH) has become prevalent because of reduced complications with more patient satisfaction. Objective: We designed and performed a prospective randomized cohort study of patients undergoing CABG to compare the results of open versus endoscopic harvesting technique. Methods: Patients who underwent elective CABG at our hospitals were divided into two groups, during the period of January 2019 to March 2021. The EVH group (50 patients) underwent endoscopic technique compared with the open vein harvesting (OVH) group (50 patients) that was underwent open surgical incision for great saphenous vein (GSV) harvesting. The two groups demographically were similar and received identical management. Leg wound was evaluated at discharge, two weeks, and four weeks for evidence of any complications. Early outcomes were recorded, including infection, gaped wound and surgical re-suture, degree of pain, level of cosmetic satisfaction, and early mobilization. Results: In the EVH group, harvesting time increased, and incision closure time decreased in comparison with OVH. The hospital stay was 5.5 ± 2.4 days in the EVH group versus 9.5 ± 2.7 days in the OVH group. Leg wound complications were significantly reduced in the EVH group in comparison with the OVH group. Conclusions: Endoscopic vein harvesting technique reduced leg wound complications. Conveniently, patients also were cosmetically satisfied.

A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery

Background: Utilisation of the Endoscopic Vein Harvesting (EVH) technique has been increasing for coronary artery bypass grafting (CABG) for the last two decades. Some surgeons remain concerned about the long-term patency of the long saphenous vein harvested endoscopically compared to traditional Open Vein Harvesting (OVH). The aim of this study was to perform a retrospective analysis of the outcomes between EVH and OVH from three UK centres with 10 years follow-up. Methods: 27,024 patients underwent CABG with long saphenous vein harvested by EVH (n=13,794) or OVH (n=13,230) in three UK centres between 2007 and 2019. Propensity modelling was used to calculate the Inverse Probability of Treatment Weights (IPTW). The primary endpoint was mortality from all causes and secondary endpoints were length of hospital stay, postoperative complications, and incidence of repeat coronary re-vascularisation for symptomatic patients. IPTW was used to balance the two intervention groups for baseline and preoperative co-morbidities. Results: Median follow-up time was 4.54 years for EVH and 6.00 years for OVH. Death from any cause occurred in 13.8% of the EVH group versus 20.8% in the OVH group over the follow-up period. The hazard ratio of death (EVH to OVH) was 0.823 (95% CI: 0.767, 0.884). Length of hospital stay was similar between the groups (p=0.86). Post-operative pulmonary complications were more common in EVH vs OVH (14.7% vs. 12.8%, p<0.001), but repeat coronary re-vascularisation was similar between the groups. Conclusion: This large retrospective multicentre analysis indicates that EVH has a lower risk of mortality compared with OVH during the follow-up period of the study. The observed benefits of EVH may outweigh the risks but should be considered on a case-by-case basis. We hope this review gives confidence to other cardiac centres that offering an EVH approach to conduit harvesting does not affect long term patient outcomes.

COMPARISON OF THE OUTCOMES AFTER ENDOSCOPIC VEIN HARVESTING VERSUS OPEN VEIN HARVESTING FOR CORONARY BYPASS SURGERY

Minimally invasive endoscopic vein harvesting (EVH) was first reported in 1996 as an alternative to open vein harvesting (OVH). Making coronary artery bypass surgery a less invasive procedure, shortly after its introduction, it became the standard of care for conduit harvesting. When compared to the conventional technique, the incidence of site infections wound dehiscence, delayed healing, duration of hospitalization, and postoperative pain were markedly reduced. However, the long-term outcomes, safety, and graft patency remain uncertain. Herein is an extensive literature review discussing the outcomes following endoscopic vein harvesting for Coronary Artery Bypass Surgery (CABG) as well as its advantages and disadvantages.

Effect of Endoscopic Versus Open Saphenous Vein Harvesting Technique on Leg Wound Complications

Background: EVH has become prevalent in recent years due to its reduced morbidity and increased patient satisfaction. We designed and carried out a prospective study of patients undergoing CABG to compare outcomes of open versus endoscopic harvesting technique for great saphenous vein. Two groups of patients who underwent elective Coronary artery bypass grafting at our hospitals between January 2018 and October 2020 were included. Endoscopic vein harvesting group (50 patients) was performed endoscopic technique compared with Open Vein Harvesting group (50 patients) was performed open surgical incision for harvesting. Both groups were demographically similar and received identical management. Leg wound was evaluated at discharge, 2 weeks, and 4 weeks for evidence of complications. Early outcomes were compared included, infection, gaped wound and re-suture, pain, satisfied cosmetically and mobilization. Results: Endoscopic vein harvesting group had increased harvest time and decreased incision closure time when compared with Open Vein Harvesting. The average hospitalization time was 6.5 ± 2.2 days for Endoscopic vein harvesting group and 9.2 ± 2.9 days for Open Vein Harvesting group. In Endoscopic vein harvesting group, no significant hematomas were observed. In Open Vein Harvesting group, hematomas were detected in 2 patients and were surgically evacuated. In Endoscopic vein harvesting group, edema occurred less frequently. Infection of the incision location did not occur in Endoscopic vein harvesting group. Leg wound complications were significantly reduced in Endoscopic vein harvesting group in comparison with Open Vein Harvesting group. Conclusions: Endoscopic vein harvesting decreases leg wound complications and increases patient’s satisfaction cosmetically.

Comparison of Life Quality in Patients Undergoing Open Vein Harvesting and Endoscopic Vein Harvesting Techniques: A Prospective Cohort Study

Background: As the traditional indicators of the operative outcomes, including morbidity and mortality, cannot give sufficient information on a patient’s physical, mental, emotional, and functional well-being alone, we aimed to compare life quality in the patients under open vein harvesting (OVH) and endoscopic vein harvesting (EVH) techniques after four years of follow-up. Methods: This prospective cohort study followed all the patients who were scheduled for off-pump CABG in the Mashhad-based Imam Reza Hospital, in October 2013, for 4 years. Accordingly, data related to their quality of life were collected, and their life quality was then compared using the WHOQOL-BREF scale. T-test and relative risk were also used. Results: This study was conducted on a total of 103 patients under the two techniques of OVH (n = 53) and EVH (n = 50). The difference between the EVH (4.7%) and OVH (16.3%) groups at the demographic characteristics was the Transient Ischemic Attack (P = 0.023). After a 4-years follow-up period, no significant differences were observed between the patients undergoing the two techniques of OVH and EVH in all the domains of life quality. Conclusions: According to the obtained results, there was no difference in the quality of life between the patients undergoing OVH and EVH techniques over a four-year period. In this regard, further investigations are recommended on the quality of life in patients under the two techniques of OVH and EVH with long-term follow-up periods.

Minimally invasive saphenous vein harvesting using the mayo vein harvester. An alternative to endoscopic vein harvesting?

The Great saphenous vein (GSV) has been widely used as a conduit for Coronary artery bypass grafting. The GSV can be harvested using the open or minimally invasive technique. Minimally invasive techniques are growing in popularity due to better cosmetic and wound infection outcomes. The most widely used method in minimally invasive technique is via endoscopic approach. However, the cost of endoscopes and training curve can limit its use. We describe an alternative minimally invasive technique using a mayo vein harvester with a considerably lower cost, and a smoother learning curve. Keywords: Saphenous vein harvesting, Mayo vein harvester, Minimally invasive

A Novel Technique of Endoscopic Vein Harvesting With Preserved Perivascular Tissue

The no-touch saphenous vein harvesting technique is considered to be the ideal procedure to achieve the best quality of vein, whereas the endoscopic vein harvesting (EVH) technique is considered to be ideal for decreasing wound complications. We developed a new technique of EVH with perivascular tissue preservation. This procedure was performed by dissecting the immediate anterior and posterior perivascular connective tissues of the saphenous vein followed by cutting approximately 1 cm laterally from the saphenous vein with the use of a harvester (MAQUET Getinge Group, Getinge AB, Göteborg, Sweden). Histopathological examination revealed preserved perivascular tissue and intimal folding.