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Updated: Aug 30, 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
Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery
Tomislav Kopjar1, Michael R Dashwood2
1Department of Cardiac Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.
Insights
Saphenous vein harvesting for coronary artery bypass surgery can be improved. New endoscopic techniques aim to enhance graft patency and reduce wound complications, benefiting patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Innovation
Background:
- The saphenous vein is a common graft for coronary artery bypass grafting (CABG), but its patency is lower than the internal thoracic artery.
- Conventional open harvesting causes vascular damage and wound complications, potentially compromising graft patency and increasing infection risk.
- Endoscopic vein harvesting (EVH) reduces wound issues but may negatively impact graft performance due to vein manipulation.
Purpose of the Study:
- To review current saphenous vein harvesting techniques for CABG.
- To evaluate the impact of different harvesting methods on vein graft patency and wound healing.
- To highlight recent advancements in endoscopic harvesting aimed at minimizing vascular damage.
Main Methods:
- Review of literature comparing open saphenous vein harvesting (OSVH) with various endoscopic vein harvesting (EVH) techniques.
- Analysis of factors influencing vein graft performance, including surgical technique and surgeon experience.
- Discussion of novel EVH methods designed for atraumatic vein retrieval.
Main Results:
- OSVH can lead to significant vascular damage and wound complications.
- EVH can reduce wound complications but may compromise graft quality if not performed carefully.
- Emerging EVH techniques show promise for obtaining intact grafts with minimal damage.
- Surgeon experience is a critical factor in achieving good outcomes with EVH.
Conclusions:
- Optimizing saphenous vein harvesting is crucial for improving CABG outcomes.
- Minimally damaging endoscopic techniques offer potential for superior graft patency and reduced surgical site morbidity.
- Further research is needed to report the long-term patency of veins harvested with newer endoscopic methods.
Abstract:
The saphenous vein is the most used conduit for coronary artery bypass surgery. However, the patency rate of this graft is inferior to the internal thoracic artery patency rate, which is the gold standard. Using the conventional technique, the saphenous vein is harvested via a large open incision and excised in such a way that causes both vascular damage and wound healing complications. Consequently, vein graft patency and surgical site infection may be compromised. Graft patency is markedly improved when the saphenous vein is harvested atraumatically with minimal damage and with surrounding cushion of perivascular fat intact. However, despite the improved graft performance, wound healing complications and infection remain a problem. Although wound healing complication is reduced when using endoscopic vein harvesting, there may be a negative impact on graft performance. This is due to vascular damage associated with application of forces to the vein that are usually avoided in open vein harvesting, including traction, adventitial stripping, and venous compression. There is evidence to suggest that improved patency of endoscopically harvested saphenous veins is associated with the surgeon's experience of the technique. Recently, endoscopic methods of harvesting have been described where the saphenous vein is removed intact and with minimal vascular damage caused. In addition, wound healing complications, infection, and scarring are reduced. While the effect of these techniques on vein graft patency have yet to be reported, the ability to obtain a superior graft with reduced wound complications will be of great benefit to patients undergoing coronary revascularization procedures.
