Endoscopic vein harvesting: technique, outcomes, concerns & controversies

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.