Leg Wound Complications: A Comparison Between Endoscopic and Open Saphenous Vein Harvesting Techniques
Endoscopic Vein Harvesting
Keywords:Endoscopic Vein Harvesting, Open Vein Harvesting, Saphenous Vein Graft, Coronary Artery Bypass Grafting, Leg Wound Complications
Background: The most common conduit for coronary artery bypass graft (CABG) surgery is saphenous vein graft (SVG). There are two techniques for SVG harvesting: open and endoscopic. Our aim is to evaluate clinical results of endoscopic versus open SVG harvesting. Nowadays, endoscopic vein harvesting (EVH) has become prevalent because of reduced complications with more patient satisfaction.
Objective: We designed and performed a prospective randomized cohort study of patients undergoing CABG to compare the results of open versus endoscopic harvesting technique.
Methods: Patients who underwent elective CABG at our hospitals were divided into two groups, during the period of January 2019 to March 2021. The EVH group (50 patients) underwent endoscopic technique compared with the open vein harvesting (OVH) group (50 patients) that was underwent open surgical incision for great saphenous vein (GSV) harvesting. The two groups demographically were similar and received identical management. Leg wound was evaluated at discharge, two weeks, and four weeks for evidence of any complications. Early outcomes were recorded, including infection, gaped wound and surgical re-suture, degree of pain, level of cosmetic satisfaction, and early mobilization.
Results: In the EVH group, harvesting time increased, and incision closure time decreased in comparison with OVH. The hospital stay was 5.5 ± 2.4 days in the EVH group versus 9.5 ± 2.7 days in the OVH group. Leg wound complications were significantly reduced in the EVH group in comparison with the OVH group.
Conclusions: Endoscopic vein harvesting technique reduced leg wound complications. Conveniently, patients also were cosmetically satisfied.
Akowuah E, Burns D, Zacharias J, Kirmani BH. 2021. Endoscopic vein harvesting. J Thorac Dis. 13(3): 1899-908.
Bitondo JM, Daggett WM, Torchiana DF, Akins CW, Hilgenberg AD, Vlahakes GJ, et al. 2002. Endoscopic Versus Open Saphenous Vein Harvest: A Comparison of Postoperative Wound Complications. Ann Thorac Surg. 73: 523– 28.
Bouhout I, Ben Ali W, Perrault LP. 2018. The effect of storage solutions on endothelial function and saphenous vein graft patency. Indian J Thorac Cardiovasc Surg. 34 (3):258 – 65.
Kalra S, Aiyer P, Bhardwaj M, Grover V, Gupta VK. 2016. A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery. Indian J Thorac Cardiovasc Surg. 32(2):113–19.
Kiaii B, Moon BC, Massel D, Langlois Y, Austin TW, Willoughby A, et al. 2002. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J Thorac Cardiovasc Surg. 123: 204-12.
Kirmani BH , Power S , Zacharias J. 2020. Long-term survival after endoscopic vein harvest for coronary artery bypass grafting. Ann R Coll Surg Engl. 102 (6): 422-8.
Liliav B, Yakoub D, Kasabian A. 2011. Case Report; Necrotizing Fasciitis Following Endoscopic Harvesting of the Greater Saphenous Vein for Coronary Artery Bypass Graft. Journal of the Society of Laparoendoscopic Surgeons. 15: 90–95.
Mandiye S, Yadav A, Pathak S, Kanhere VM, Pande H. 2007. Extended length endoscopic harvest of the great saphenous vein for coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg. 23: 125-27.
Moshkovitz Y, Raanani E. 2016. The art of saphenous vein grafting and patency maintenance. J Thorac Cardiovasc Surg. 151: 300-2.
Nezafati MH, Nezafati P, Amoueian S, Attaranzadeh A, Rahimi HR. 2014. Immunohistochemistry comparing endoscopic vein harvesting vs. open vein harvesting on saphenous vein endothelium. J Cardiothorac Surg. 9:101- 8.
Raja SG, Sarang Z. 2013. Endoscopic vein harvesting: technique, outcomes, concerns and controversies. J Thorac Disease. 5(6): 630- 37.
Raghuram AR, John EV, Kumar S, Balamurugan K, Amol D, Murugadoss S, et al. 2007. Early experience of endoscopic vein harvesting for CABG. Indian J Thorac Cardiovasc Surg. 23: 188-91.
Raza S, Chang C, Deo SV, Sabik JF. 2018. Current role of saphenous vein graft in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg. 34:245-50.
Siddiqi MS. 2016. Saphenous vein harvest wound complications: risk factors, identification, prevention, and management. Chronic Wound Care Management and Research. 3: 147–56.
Tamura K, Maruyama T, Sakurai S. The back-approach technique of endoscopic saphenous vein harvesting in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg.
Zenati MA, Bhatt DL, Stock EM, Hattler B, Wagner TH, et al. 2021. Intermediate-Term Outcomes of Endoscopic or Open Vein Harvesting for Coronary Artery Bypass Grafting The REGROUP Randomized Clinical Trial. JAMA Netw Open. 4(3):e211439.
Zenati MA, Shroyer AL, Collins JF, Hattler B, Ota T, Almassi GH, et al. 2011. Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. J Thorac Cardiovasc Surg. 141:338-44.
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