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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Is it safe to perform endoscopic vein harvest?
Charlene Tennyson1, Christopher P Young, Marco Scarci
1King's College Medical School, London, UK.
Interactive Cardiovascular and Thoracic Surgery
|January 27, 2010
Summary
Endoscopic vein harvesting (EVH) offers reduced postoperative pain and wound complications in coronary revascularization patients, improving satisfaction. However, concerns exist regarding long-term graft patency and potential increases in adverse cardiac events compared to open harvest.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Vascular Grafting
Background:
- Coronary revascularization frequently utilizes saphenous vein grafts.
- Traditional open vein harvesting (OVH) is associated with significant postoperative morbidity.
- Endoscopic vein harvesting (EVH) emerged as a less invasive alternative.
Purpose of the Study:
- To compare the clinical outcomes and cost-effectiveness of endoscopic vein harvesting (EVH) versus open harvest (OVH) in patients undergoing coronary revascularization.
- To evaluate the impact of EVH on postoperative pain, wound complications, hospital stay, and graft patency.
- To assess the long-term clinical event rates associated with EVH compared to OVH.
Main Methods:
- A systematic review of >166 papers was conducted, focusing on eight high-quality studies representing the best evidence.
- Data on postoperative pain scores, wound complication rates, length of hospital stay, and graft occlusion were extracted and analyzed.
- Meta-analysis was performed using weighted mean differences (WMD) and confidence intervals (CI) for continuous variables.
Main Results:
- EVH significantly reduced postoperative pain (P=0.03) and wound complications compared to OVH.
- Patients undergoing EVH experienced a shorter hospital stay (WMD -1.04 to -0.85; P=0.02).
- While short-term occlusion rates were similar, medium- to long-term graft occlusion was higher with EVH (46.7% vs. 38.0% at 12-18 months).
- EVH was associated with increased rates of death, myocardial infarction, or repeat revascularization at three years (20.2% vs. 17.4%; P=0.04).
Conclusions:
- Endoscopic vein harvesting (EVH) provides significant short-term benefits, including reduced pain, fewer wound complications, and shorter hospital stays, leading to high patient satisfaction.
- However, evidence suggests potential concerns regarding the medium- to long-term patency of endoscopically harvested grafts.
- A recent sub-analysis indicates EVH may be associated with higher rates of adverse cardiovascular events and mortality in the long term, warranting careful consideration.
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