A Comparative Analysis on Surgical Outcomes and Complications of Endoscopic and Open Vein Harvesting Techniques

Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.

Endoscopic vein harvest in elective off-pump coronary artery bypass grafting

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hema-toma, pain scale, and superficial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preopera-tive risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complica-tions and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.

Evaluations of endoscopic vein harvesting in coronary artery bypass grafting surgery

Compared with the open saphenous vein harvesting （OVH）, there is a larger decrease in inci-sion complications of endoscopic vein harvesting （EVH）. Fewer studies were conducted to evaluate the quality of great saphenous vein （SVG） harvesting by these two methods. To apply transit time flow measurement （TTFM） to SVG grafts in coronary artery bypass grafting （CABG）, we properly evaluate the quality of SVG and surgical effect. Methods From January 2012 to August 2012, 38 cases underwent EVH and 16 cases underwent OVH. We recorded pulsatility index （PI）, mean graft flow （MGF） and diastolic flow （DF） of SVG grafts for statistical analysis. The dysfunctional grafts diagnostic criteria is PI 〉 5, MGF 〈 10 mL/min or DF 〈 50%. Result In terms of SVG grafts, no significant difference existed in the length of two groups （P = 0.2395）. EVH group har-vesting time was longer than OVH group （P = 0.0113）, but the incision length of EVH group was shorter （P = 0.0000） and it needed less suture time. EVH group presented no significant differences in incision complication rate from OVH group （P = 0.7055） within 1 month after surgery. TTFM data of well functioning grafts had no significant difference in the two groups （PI： 3.2 ± 1.0 vs. 2.9 ± 0.9, MGF： 34.7 ± 20.4 vs. 36.3 ± 19.2 mL / min, DF： 66.3% ± 10.6% vs. 68.5% ± 10.3%）. There was no significant difference in the rate of dysfunctional grafts in two groups （P = 0.7954） as well. The cause for tomosed the grafts with satisfactory effect. Conclusion vesting methods. The surgical effect and the quality of quality of SVG grafts can be reasonably evaluated by TYFM.