Our experience with endoscopic vein graft harvesting – preliminary results

Overview

Objectives:
The purpose of this study is to compare opened (OVH) and the endoscopic (EVH) great saphenous vein harvest techniques in coronary surgery. Leg wound morbidity, total patient morbidity, endothelium damage and bypass grafts patency will be observed. Our initial results summarize the effect on patient morbidity.

Backgrounds:
The great saphenous vein is the most common coronary bypass graft. The endoscopic harvest technique has been available since 1998. Expansion of the method demands a comparison of the influence of harvest techniques on patient morbidity, endothelium traumatisation and bypass graft patency.

Methods:
In a prospective study, following great saphenous vein USG-mapping, 100 consecutive patients undergoing elective CABG where randomized into EVH and OVH group. The graft harvest data and perioperative complications were observed. The wound healing and leg morbidity were recorded on day 7 after the procedure and 1 month after dimission.

Results:
The length of grafts in the EVH and OVH groups were similar (36.9 cm EVH and 38.4 cm OVH), the harvest time was 36.2 minutes and 37.7 minutes. The skin incisions length was 7.6 cm in EVH and 40.3 cm in the OVH group. Clinical follow-up at day 7 shows higher incidence of large haematoma in the EVH group (18 % vs. 2 %), but lower incidence of pain (12 % vs. 42 %), edema of extremity (8 % vs.26%) and n.saphenus-region dysaesthesia (0 % vs. 10%).

The incidence of edema, pain and dysaesthesia is lower in EVH also one month after dimission. There is no more difference in incidence of haematomas.

Conclusions:
EVH has fewer wound healing complications and a much better cosmetic outcome compared with OVH.

Key words:
coronary artery bypass grafting; saphenous vein; endoscopic vein harvesting; opened vein harvesting; wound healing complications.