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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
Endoscopic vein harvesting: technique, outcomes, concerns & controversies
Shahzad G Raja1, Zubair Sarang
1Department of Cardiac Surgery, Harefield Hospital, London, UK;
Insights
Endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) offers benefits like reduced pain and complications compared to open vein harvesting (OVH). However, concerns about graft patency hinder its widespread adoption.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Innovation
Background:
- Graft conduit choice significantly impacts coronary artery bypass grafting (CABG) outcomes.
- Internal mammary artery is preferred for long-term patency, but long saphenous vein (LSV) is widely used for multi-vessel revascularization.
- Traditional open vein harvesting (OVH) of LSV causes significant wound morbidity and patient dissatisfaction.
Purpose of the Study:
- To review the technical aspects, outcomes, and controversies of endoscopic vein harvesting (EVH) in CABG.
- To compare EVH with OVH regarding wound complications, patient satisfaction, and graft patency.
- To address concerns hindering the universal adoption of EVH.
Main Methods:
- Review of published literature comparing endoscopic vein harvesting (EVH) and open vein harvesting (OVH).
- Analysis of data on wound-related complications, postoperative pain, hospital stay, and patient satisfaction.
- Evaluation of studies addressing the impact of EVH on vein graft patency and long-term clinical outcomes.
Main Results:
- Endoscopic vein harvesting (EVH) is associated with decreased wound complications, improved patient satisfaction, shorter hospital stays, and reduced postoperative pain compared to open vein harvesting (OVH).
- Concerns persist regarding potential injury during EVH and its detrimental effect on vein graft patency and clinical outcomes.
- Published data suggest benefits of EVH, yet its universal adoption is limited by these concerns.
Conclusions:
- Endoscopic vein harvesting (EVH) presents significant advantages over open vein harvesting (OVH) in terms of wound morbidity and patient experience.
- Further research and standardization are needed to address concerns about graft patency and ensure the safe and effective widespread adoption of EVH in coronary artery bypass grafting (CABG).
- Balancing the benefits of EVH with potential risks is crucial for optimizing patient outcomes in CABG procedures.
Abstract:
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.
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