Risk Factors for Leg Wound Complications Following Endoscopic Versus Traditional Saphenous Vein Harvesting

Authors

  • Keith B. Allen Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • David A Heimansohn Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • Robert J. Robison Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • John J. Schier Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • Gary L. Griffith Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • Edward B. Fitzgerald Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • John H. Isch Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • Simon Abraham Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN
  • Carl J. Shaar Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN

Abstract

Background: Risk factors for leg wound complications following traditional saphenectomy have included: obesity, diabetes, female gender, anemia, age, and peripheral vascular disease. Use of an endoscopic saphenectomy technique may modify the risk factor profile associated with a traditional longitudinal incision.

Methods: From September 1996 to May 1999, 276 consecutive patients who underwent elective isolated coronary artery bypass grafting performed by a single surgeon (K.B.A.) had their greater saphenous vein harvested endoscopically. During the period from January 1999 to May 1999, the surgical records of 643 patients who underwent the same operation and had a traditional longitudinal saphenectomy were reviewed for postoperative leg wound complications. Group demographics were similar regarding preoperative risk stratification and traditionally identified wound complication risk factors (diabetes, gender, obesity, preoperative anemia, and peripheral vascular disease). Leg wound complications were defined as: hematoma, dehiscence, cellulitis, necrosis, or abscess requiring dressing changes, antibiotics and/or debridement prior to complete epithelialization. Follow-up was 100% at six weeks.

Results: Leg wound complications following endoscopic harvest occurred in 3% (9/276) of patients versus 17%(110/643) of traditional harvest patients (p<0.0001). No univariate risk factors for wound complications were associated with endoscopic saphenectomy. Univariate predictors of wound complications following traditional saphenectomy included: diabetes (p=0.001), obesity (p=0.0005), and female gender (p=0.005). Multivariable risk factors for leg wound complications following saphenectomy were traditional harvest technique (OR 7.56, CI 3.8–17.2, p<0.0001), diabetes (OR 2.10, CI 1.4–3.2, p=0.0006) and obesity (OR 1.82, CI 1.2–2.8, p=0.007).

Conclusions: Traditional longitudinal saphenectomy is a multivariable risk factor for development of leg wound complications. Endoscopic saphenectomy modifies the risk factor profile for wound complications and should be the standard of care, particularly for obese and/or diabetic patients who require venous conduit during coronary artery bypass grafting.

Published

2000-12-01

How to Cite

Allen, K. B., Heimansohn, D. A., Robison, R. J., Schier, J. J., Griffith, G. L., Fitzgerald, E. B., Isch, J. H., Abraham, S., & Shaar, C. J. (2000). Risk Factors for Leg Wound Complications Following Endoscopic Versus Traditional Saphenous Vein Harvesting. The Heart Surgery Forum, 3(4), E325-E330. Retrieved from https://journal.hsforum.com/index.php/HSF/article/view/6507

Issue

Vol. 3 No. 4 (2000)

Section

Article
Author Disclosure & Copyright Transfer Agreement