Minimally invasive saphenous vein harvesting techniques: morphology and postoperative outcome

Fabricius, Alexander; Diegeler, Anno; Doll, Nicolas; Weidenbach, H.; Mohr, Friedrich W.

doi:10.1016/s0003-4975(00)01370-9

Cited by 56 publications

(33 citation statements)

References 18 publications

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“…Overall, 22 of the studies reported the incidence of post-operative haematoma [4][5][6][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33]37], with seven of these showing a statistically significant reduction in the MIVH as compared to the CVH group. Eleven of the studies were randomised [4][5][6][15][16][17][18][19][20][21][22], with metaanalysis of these calculating an incidence of haematoma of 53/676 (8%) in MIVH and 93/610 (15%) in CVH groups, with an odds ratio (OR) of 0.43 and confidence interval (CI) of 0.23-0.79, suggesting that this difference is statistically significant.…”

Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

“…Eleven of the studies were randomised [4][5][6][15][16][17][18][19][20][21][22], with metaanalysis of these calculating an incidence of haematoma of 53/676 (8%) in MIVH and 93/610 (15%) in CVH groups, with an odds ratio (OR) of 0.43 and confidence interval (CI) of 0.23-0.79, suggesting that this difference is statistically significant. When considering 12 studies that were fully matched for the patient criteria previously mentioned [4][5][6]15,16,18,19,[21][22][23]32,33], these results were reproduced, with an incidence of haematoma of 50/840 (5%) with MIVH as compared to 88/764 (11%) with CVH (OR 0.46, CI 0.23-0.92).…”

Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

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Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Athanasiou

Aziz

Al‐Ruzzeh

et al. 2004

European Journal of Cardio-Thoracic Surgery

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Minimally invasive great saphenous vein harvest for coronary artery bypass grafting aims to reduce post-operative leg-wound related morbidity. In a meta-analysis of randomised trials we have shown leg wound infection rates to be significantly lower in patients undergoing minimally invasive harvest. This study aims to use meta-analysis to compare the two techniques with regards to non-infective wound healing disturbances (NIWHD) (wound drainage, haematoma, dehiscence, necrosis, need for surgical debridement, and seroma formation). A meta-analysis of all studies published between 1995 and 2002 reporting a comparison between the two techniques was performed. Primary outcomes of interest were the six wound healing disturbances mentioned above and length of hospital stay. Heterogeneity was assessed using graphical exploration and sensitivity analysis with subgroup analysis. Twenty-seven studies published between 1997 and 2002 matched our selection criteria, with a combined total of 4953 subjects, of which 2442(49%) underwent minimally invasive harvest and 2511(51%) underwent conventional surgery. When considering only randomised studies, the total number of non-infective wound disturbances was lower in minimally invasive (4%) as compared to the conventional (13%) group (random effect OR 0.24, CI 0.16-0.38). Similar results were found when only fully matched studies were considered. The absolute risk reduction when comparing the two techniques was calculated to be 0.10, which translates to a number of patients needed to treat of 10. Length of stay was significantly reduced in the minimally invasive group in comparison to the conventional group (random effect weighted mean difference of -1.04, CI -1.92 to -0.16). Our results suggest that NIWHD all reduced with minimally invasive harvest techniques. Despite the limitations of this meta-analysis, we feel we have once again illustrated an important link between minimally invasive great saphenous vein harvest and improved tissue healing when compared to conventional open surgery. This has the potential to reduce wound-related morbidity, infection, post-operative pain, length of hospital stay, and re-admission rate.

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Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

Section: Meta-analysis Of Haematoma Resultsmentioning

confidence: 99%

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Athanasiou

Aziz

Al‐Ruzzeh

et al. 2004

European Journal of Cardio-Thoracic Surgery

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“…Endothelial dysfunction has been reported with traction injury during vein harvesting with bridged incisions, but not with EVH [27]. In this regard, EVH has not been shown to compromise the histologic integrity [24,25,28] or functional properties [21,26,29] of the endothelial, medial and adventitial layers.…”

Section: Discussionmentioning

confidence: 99%

“…EVH can be easily adopted and accomplished in a decent time and has been shown to reduce postoperative pain, discomfort and additional woundrelated morbidities. Furthermore, histologic evaluation [9,14,[24][25][26]28] shows no significant trauma to the saphenous vein. …”

Section: Discussionmentioning

confidence: 99%

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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“…Surgical techniques used to harvest venous conduits are to preserve, thereby guaranteeing graft quality. Previous studies on porcine veins [17] and human saphenous veins [18] evaluated the morphological integrity by histology and scanning electron microscopy, and have shown the endothelial layer to be preserved. Biological endothelial integrity is required for NO production in the saphenous veins and internal mammary artery [19], and inhibition of platelet deposition [20].…”

Section: Commentmentioning

confidence: 99%

Endothelial function of human vena saphena magna prepared with different minimally invasive harvesting techniques

Fabricius

Oser

Diegeler

et al. 2000

European Journal of Cardio-Thoracic Surgery

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Objectives: Minimally invasive saphenous harvesting techniques have been shown to reduce post-operative morbidity. However, when applying new techniques of vein harvesting, endothelial integrity should be preserved in order to guarantee graft quality. We investigated the impact of two different minimally invasive saphenous vein harvesting techniques on endothelial function compared with the traditional open' technique by inducing endothelium-dependent in vitro relaxation. Methods: Two different minimally invasive techniques for harvesting the greater saphenous vein were used in 66 patients, either using a video-assisted dissector (ETHI, n 33) or a light coupled retractor (AUTS, n 33); other patients were treated conventionally (CONV, n 30). The physiological response was tested in vitro using an organ chamber on vein segments exposed to acetylcholine after precontraction with potassium. Results: In both minimally invasive groups, two patients each had to be converted to the traditional open technique and dropped out of the study. The endothelial function of the other veins harvested by either of the minimally invasive techniques showed no signi®cant difference compared with veins harvested conventionally. Reactivity was measured as the percentage relaxation of pharmacological contraction and was signi®cant in all groups (P , 0:05); ETHI, 49.1^4.2%; AUTS, 48.8^5.1%; and CONV, 51.7^6.0%. The responder/non-responder ratio was similar in all groups: ETHI (two drop-outs), 28/3 (90.3%); AUTS (two drop-outs), 28/3 (90.3%); and CONV, 27/3 (90.0%). Conclusion: Veins harvested by minimally invasive techniques have not shown an impaired reactivity of the endothelium compared with the conventional technique. q

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Minimally invasive saphenous vein harvesting techniques: morphology and postoperative outcome

Cited by 56 publications

References 18 publications

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis

Endoscopic vein harvesting in coronary artery bypass surgery

Endothelial function of human vena saphena magna prepared with different minimally invasive harvesting techniques

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