The back-approach technique of endoscopic saphenous vein harvesting in coronary artery bypass grafting
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Updated: Nov 21, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Kiyoshi Tamura1, Toshiyuki Maruyama1, Shogo Sakurai1
1Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama 340-8560 Japan.
Insights
This study introduces a novel back-approach technique for endoscopic saphenous vein harvesting (EVH) during coronary artery bypass grafting (CABG). The technique demonstrated reduced wound complications and shorter hospital stays with comparable graft patency to traditional methods.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Vascular Grafting
Background:
- Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) carries a risk of vascular injury to the vein or its branches.
- Bipolar electrocautery scissors used in EVH can cause damage, potentially reducing graft patency.
Purpose of the Study:
- To describe a novel back-approach technique using a C-ring for dividing saphenous vein side branches during EVH.
- To assess the early outcomes of EVH utilizing this new technique.
Main Methods:
- A cohort of 169 patients undergoing CABG was studied, comparing the novel EVH technique (n=44) with open vein harvesting (OVH) (n=125).
- The EVH method involved a small incision, careful dissection, and the C-ring back-approach technique for side branch division.
- Primary endpoint was graft patency; secondary endpoints included leg wound complications and hospitalization duration.
Main Results:
- Early saphenous vein graft patency rates were comparable between EVH and OVH groups (95.6% vs. 94.7%).
- The EVH group showed a significantly lower incidence of lower extremity wound lymphorrhea (0.0% vs. 16.0%).
- Hospitalization length was significantly shorter in the EVH group (19.0 days vs. 24.2 days).
Conclusions:
- Endoscopic saphenous vein harvesting using the novel back-approach C-ring technique yields satisfactory short-term results.
- This technique appears effective for vein harvesting in EVH, offering benefits in wound healing and hospital stay duration.
Purpose:
One of the concerns during endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG) is injury to the vein or its branches. The cutting edge of bipolar electrocautery scissors, used to divide the side branches of the saphenous vein, can cause vascular injury leading to reduced graft patency. We have developed a novel back-approach technique using a C-ring to divide the wide side branches of the saphenous vein during EVH. The aim of the study was to describe the technique and assess early outcomes of EVH using this technique. The back-approach technique is as follows: (a) insert the C-ring near the target branch, (b) push the C-ring over the proximal aspect of the target branch, (c) twist the C-ring forward to capture the target branch, and (d) cut the target branch by bipolar electrocautery.
Methods:
We investigated 169 patients, including 35 women (mean age 70.1 ± 8.9 years), who underwent CABG at our hospital, using a novel EVH technique. The patients were categorized as those who underwent EVH (EVH group, n = 44) or open vein harvesting (OVH) (OVH group, n = 125). This method involves the creation of a small incision (2 cm), sufficient saphenous vein dissection near the skin incision, adequate dissection to separate the vein from the surrounding tissues, and the back-approach technique with C-ring to divide the side branch of the saphenous vein. The primary endpoint was the graft patency rate, and the secondary endpoints were leg wound complications and length of hospitalization.
Results:
No significant intergroup difference was observed in early patency of saphenous vein graft patency (OVH vs. EVH = 94.7 vs. 95.6%, p = 0.763). The incidence of lower extremity wound lymphorrhea was significantly lesser (OVH: EVH = 16.0: 0.0%, p = 0.005) and the length of hospitalization was also significantly shorter in the EVH group (OVH vs. EVH = 24.2 ± 9.8 vs. 19.0 ± 5.3 days, p = 0.001).
Conclusions:
EVH, using the back-approach technique, showed satisfactory short-term results; therefore, this technique performed with C-ring might be effective for vein harvesting during EVH.
