Long-term patency of coronary grafts with endoscopically harvested saphenous veins determined by contrast-enhanced electron beam computed tomography

Davis, Zev; Garber, Dave; Clark, Stanley W.; Roth, H; Bufalino, Vincent J.; Budoff, Matthew J.; Mao, Songshou; Jacobs, H. K.

doi:10.1016/j.jtcvs.2003.10.051

Cited by 22 publications

(17 citation statements)

References 24 publications

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“…Acute perioperative events that might be associated with severe graft trauma have been observed for both endoscopic and open harvest techniques with similar frequencies [8]. However, premature graft failure that might be attributed to EVH has not been reported in long term follow-up [14][15][16][17]23]. In our series we did not find any early graft failure, clot formation in the harvested vein nor increased perioperative or intraoperative myocardial infarction.…”

Section: Discussionsupporting

confidence: 66%

“…Moreover, the short-term 6 month patency rate of EVH veins, as assessed by contrast-enhanced electron beam computed tomography [16] Allen et al [14] showed similar 5-year event-free survival rates (freedom from death, myocardial infarction, recurrent angina, or congestive heart failure) 75% endoscopic versus 74% open harvest, p ¼ 0.85.…”

Section: Discussionmentioning

confidence: 99%

“…In 1996, Lumsden et al [13] proposed harvesting the saphenous vein using a video endoscope as an alternative approach to the traditional technique and termed the procedure endoscopic vein harvesting (EVH). Since then, several investigators have reported the advantage of EVH and demonstrated reduced wound infection rates as well as decreased noninfective woundrelated morbidity within a follow-up period up to 5 years [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic vein harvesting in coronary artery bypass surgery

et al. 2007

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Endoskopische Venenentnahme fü r aortokoronare BypassoperationenZusammenfassung. Grundlagen: Wundheilungsstö -rungen und Wundinfektionen am Bein nach Entnahme der Vena saphena magna (VSM) fü r aorto-coronare Bypassoperationen (CABG) stellen eine schwerwiegende Komplikation dar. Speziell bei Patienten mit Adipositas, Diabetes mellitus und peripheren Durchblutungsstörungen treten vermehrt tiefreichende Wundheilungsstö rungen mit starken Schmerzen auf.Methodik: Unser Ziel war es, die Anwendbarkeit und die Ergebnisse der endoskopischen Beinvenenentnahme zu untersuchen. Von Oktober 2002 bis November 2005 setzten wir bei 63 Patienten mit koronarer Herzerkrankung, die sich einer CABG-Operation unterziehen mussten, das VasoView + System der Fa. Guidant zur endoskopischen Entnahme der VSM ein. Wir untersuchten Entnahmezeit und Prä parationszeit der Vene, intraoperative Komplikationen und Konversion zur offenen Entnahmetechnik, Qualitä t der entnommen Vene und Anzahl an Reparaturnä hten, Flowwerte der eingesetzten Venengrafts und postoperative Wundkomplikationen.Ergebnisse: Die mittlere Entnahmezeit betrug 37,5 min (19-72 min). Aufgrund von Blutungen und Fettgewebsansammlungen im Prä parationskanal musste bei 4 Patienten zur offenen Entnahmetechnik konvertiert werden. Die Qualitä t der prä parierten Venen wurde mit einem Score von 1,4 auf einer Skala von 1-5 beurteilt. Die Seitenä ste wurden ligiert und geklippt, im Mittel mussten 1,4 Lö cher pro Vene von ausgerissenen Seitenä sten mit Prolene ü bernä ht werden. Bei einer Patientin war die Wand der endoskopisch entnommenen VSM zu dü nn und varikö s, sodass die Vene nicht als Bypassgraft verwendet werden konnte.Bei 17 Patienten (29%) wurde aus der endoskopisch prä parierten Vene ein Graft eingesetzt, bei 37 Patienten (64%) 2 Grafts und bei 4 Patienten (7%) 3 Grafts. Die Flowwerte der eingesetzten Grafts waren im Mittel 50 ml=min (10-159 ml=min). Postoperativ traten bei 22 Patienten (37%) umschriebene Hä matome entlang des Prä parationskanals auf, die bei Entlassung gä nzlich zurü ckgegangen waren. Wundheilungsstö rungen und Wundinfektionen am Bein traten bei keinem der Patienten auf.Schlussfolgerungen: Die Vorteile der endoskopischen Entnahmetechnik der VSM sind die geringere Traumatisierung des Beines und die schmerzfreie und schnellere Mobilisierbarkeit der Patienten. Die Prä parationszeit der Vene ist trotz ,,learning curve'' akzeptabel. Die Operationszeit wird nicht verzö gert. Die Visualisierung ist ausgezeichnet und die Handhabung des Systems ist schnell erlernbar. Die prä parierten Venen sind mit dieser Entnahmetechnik den konventionell offen entnommenen Venen ebenbü rtig, mit dem Vorteil der geringeren postoperativen Schmerzen und dem besseren kosmetischen Ergebnis. Die Konversionsrate zur offenen Technik ist gering (4 von 63). Postoperative Wundkomplikationen sind nicht zu erwarten.Schlü sselwö rter: Endoskopische Venenentnahme, aortokoronare Bypassoperationen.Summary. Background: Leg wound complications and infections after harvesting of the greater saphenous vein...

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic vein harvesting in coronary artery bypass surgery

et al. 2007

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“…Subsequent angiographic studies of patency rates and scanning electron microscopy (SEM) assays of intimal integrity have disputed these conclusions [2,11,15]. Davis et al analysed the long-term (approximately 3 years) patency of vein grafts using contrast-enhanced electron beam CT and showed that graft patency rate of endoscopically harvested veins was better than that of traditionally harvested veins [16]. Studies analysing long-term outcome of EVH have even reported a significant reduction in mortality (hazard ratio 0.74) [16].…”

Section: Discussionmentioning

confidence: 99%

“…Davis et al analysed the long-term (approximately 3 years) patency of vein grafts using contrast-enhanced electron beam CT and showed that graft patency rate of endoscopically harvested veins was better than that of traditionally harvested veins [16]. Studies analysing long-term outcome of EVH have even reported a significant reduction in mortality (hazard ratio 0.74) [16]. The overall patency rate depends on the target and vein-related variables and patient characteristics rather than the method of vein harvesting [8].…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery

Kalra

Aiyer

Bhardwaj

et al. 2016

Indian J Thorac Cardiovasc Surg

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Purpose The great saphenous vein harvested with a traditional open technique often results in leg wound complications.An endoscopic harvesting technique may decrease incidence of these complications. Methods and material Fifty consecutive patients having elective primary coronary artery bypass surgery were prospectively and randomly assigned to either endoscopic great saphenous vein harvesting (EVH-group A) or open great saphenous vein harvesting (OVH-group B). Both groups were demographically similar and received identical management. Leg wound healing was evaluated at discharge, 1 week, 1 month and 6 months for evidence of complications. Result The patient in endoscopic vein harvesting group had increased harvest time and an insignificant increase in vein injuries at the time of harvesting but decreased incision closure times when compared with traditional longitudinal open vein harvesting. Conversion from endoscopy to a traditional longitudinal open vein harvest occurred in 5 % of patients. Leg wound complications were significantly reduced postoperatively in the endoscopic vein harvesting group in comparison with the open vein harvesting group. Histological evaluation of structural integrity of vein samples shows that there is no significant difference between both the groups. No patient was readmitted to the hospital for leg wound complications in either group.Conclusion EVH is a safe, reliable method for saphenous vein harvesting. The best indication for EVH may be in patients who are in increased risk for wound infection and in whom cosmetics is a major concern.

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Minimally Invasive Saphenous Vein Harvesting for Coronary Artery Bypass Grafting

Slater

Arterial Grafting for Coronary Artery Bypass Surgery

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Long-term patency of coronary grafts with endoscopically harvested saphenous veins determined by contrast-enhanced electron beam computed tomography

Cited by 22 publications

References 24 publications

Endoscopic vein harvesting in coronary artery bypass surgery

Endoscopic vein harvesting in coronary artery bypass surgery

A prospective randomized trial of endoscopic versus open saphenous vein harvesting technique for coronary artery bypass graft surgery

Minimally Invasive Saphenous Vein Harvesting for Coronary Artery Bypass Grafting

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