[Endoscopic saphenous vein harvesting for coronary artery bypass grafting].

BACKGROUND

Traditional great saphenous vein harvest for coronary artery bypass grafting is associated with a significant risk of impaired wound healing. Endoscopic saphenous vein harvesting (EVH) has been introduced in an effort to reduce the incidence of leg-wound complications, whereas the histological quality and long-term patency of harvested grafts are comparable with grafts harvested by means of traditional technique.

METHODS

From July to December 2005, EVH was performed in a group of 60 patients employing the Vasoview 6 system (Guidant, Europe S.A., Belgium). Patients were evaluated on 7th postoperative day for wound healing disturbances, residual leg oedema and saphenous neuropathy.

RESULTS

The mean age was 67.4 +/- 11.2 years, male patients dominated (68%). At least one independent risk factor of leg-wound disturbances such as obesity, diabetes, peripheral vascular disease and female gender, was presented in 39 patients (63%). The mean number of harvested venous grafts was 2.0 +/- 1.2 and the mean total vein harvesting time was 46.2 +/- 7.4. In one case (1.7%), EVH was converted to the traditional harvesting technique due to superficial course of the great saphenous vein. The presence of wound haematoma was noted in 31 patients (51%). No other wound disturbances such as wound infection, wound dehiscence, skin necrosis, lymphatic wound drainage, nor saphenous neuropathy were recorded in the group of patients. The leg oedema associated with EVH was presented in 7 patients (12%).

CONCLUSIONS

EVH is a safe method associated with a significant reduction of leg-wound complications, residual leg oedema and saphenous neuropathy. EVH should become method of choice, particularly in the presence of independent risk factors of leg-wound disturbances. The quality and the harvesting time of harvested grafts were comparable to grafts harvested by means of the traditional harvesting technique.