Recent progress in minimally invasive conduit harvesting

Wound-related morbidity frequently encountered after open-incision harvesting of vessel conduits for coronary artery bypass grafting (CABG) is invariably recognized as an obstacle impeding the patient's path towards complete postoperative recovery. The endoscopic approach provides surgical access to the intended conduit vessel while affording an appreciably lower incidence of traumatic injury to the surrounding tissues. For this reason, the minimally invasive endoscopic dissection of vessel conduits is steadily gaining acceptance as a preferable alternative to the standard open-incision technique. Endoscopic systems, originally developed for general surgical procedures in the early 1990s, and readily adapted to saphenous vein harvesting by mid-decade, are now also being applied to minimally invasive radial artery harvesting. The growth of this surgical modality has paralleled the rapid development of remote access minimally invasive endoscopic devices and technologies and therefore remains an evolving body of knowledge. As experience and refinements in instrumentation progress, the endoscopic approach will undoubtedly become the procedure of choice for harvesting vessel conduits. This article provides a practical primer, based on the benefit of our serial experience with endoscopic vein and radial artery dissections, for those considering the minimally invasive endoscopic approach in harvesting vessels for CABG.     

Endoscopically assisted in situ lower extremity bypass graft: a preliminary report of a new minimally invasive technique.

OBJECTIVE: Lower extremity arterial reconstructions with in situ greater saphenous vein (GSV) are an important component of limb salvage surgery. Initially, the procedure was performed through continuous skin incisions for side branch occlusion and valve lysis with a wound complication rate of 5% to 25%. To decrease these complications, we used endoscopic GSV harvest equipment in 25 in situ vein bypass grafts in 25 patients performed over 24 months. METHODS: The procedures were performed with three skin incisions: two for arterial access and a 2-cm incision above the knee to insert the Endopath device (Ethicon) to locate and clip the GSV side branches. After completion of the proximal anastomosis, the valves were lysed through the distal end of the vein with a flexible valvulotome. Completion cineangiography was performed to confirm side branch occlusion and evaluate the entire reconstruction. The results of this technique were compared with our last 25 in situ bypass grafts done with standard long incisions. RESULTS: In the endoscopic group there was one (4%) minor wound complication (cellulitis). No postoperative arteriovenous fistulas were detected by means of duplex examination, and the average hospital stay was 6.2 +/- 1 days. One graft closed at 9 months as a result of distal vein hyperplasia, but the other grafts have remained patent, with follow-up from 6 to 30 months (mean, 18 months). Patients with the standard in situ bypass grafts had significantly (P < .05) more wound complications (20%) and longer average hospital stay (9.2 +/- 2 days) than the endoscopic group. Patency rates were comparable for both groups. CONCLUSION: These results show that less invasive endoscopic in situ bypass grafting minimizes wound complications and reduces the need for hospitalization without decreasing patency or increasing operative time.     

Comparison of initial limb salvage in 98 consecutive patients with either reversed autogenous or in situ vein bypass graft procedures

A retrospective review of 98 consecutive patients undergoing femoropopliteal or distal bypass procedures was conducted to determine whether in situ bypass grafting offers statistically significant initial limb salvage over reversed autogenous techniques. Over a 40 month period, 98 consecutive patients received either in situ or reversed autogenous vein grafts to effect limb salvage. The groups were similar in incidences of diabetes and previous myocardial infarctions, as well as in site of distal anastomosis (beneath the tibial peroneal trunk in more than 80 percent). The in situ vein graft group had an overall limb salvage rate of 92 percent with an 88 percent cumulative patency rate at 4 to 18 month follow-up, whereas the reversed autogenous vein graft group had a limb salvage rate of 86 percent with a 79 percent cumulative patency rate at up to 18 months. Results after 30 days showed 47 patients had improvement and 3 patients (6 percent) had died in the in situ vein graft group. In the reversed autogenous vein graft group, 44 patients improved, 4 did not improve and required amputations, and 2 (1 percent) died. Our study supports the use of in situ vein bypass grafting for limb salvage.     

Non-greater saphenous vein grafting for infrageniculate bypass

Infrainguinal bypass grafting with greater saphenous vein has proven to be a highly effective procedure with primary 5-year patency and limb salvage rates exceeding 80 per cent. However, because of prior usage or intrinsic venous disease the greater saphenous vein is often not available as a conduit. Numerous studies have shown that patency rates for prosthetic bypass grafting to the infrageniculate vessels are clearly inferior to that reported for greater saphenous vein bypass. In this report we summarize our experience with the use of alternate autogenous vein grafting to the infrageniculate vessels. The records of all patients undergoing autogenous bypass grafting to the infrageniculate vessels using a conduit other than the greater saphenous vein between 1992 and 1999 were reviewed. Graft survival curves were plotted using the Kaplan-Meier method and results are reported using the Society for Vascular Surgery/International Society for Cardiovascular Surgery guidelines. Forty-eight patients underwent a total of 51 infrageniculate bypass procedures using non-greater saphenous autogenous conduits. Thirty-nine patients had reconstructions performed with single segments of arm vein, two had their operations performed with lesser saphenous vein, and ten had grafts created with two segments of non-greater saphenous autogenous vein. Twenty-one grafts were performed to the infrageniculate popliteal artery and 30 were performed to the tibial vessels. Primary and primary assisted patency rates at 30 months were 49 and 75 per cent. Limb salvage was 87 per cent. Infrainguinal bypass grafting using non-greater saphenous autogenous conduits can yield quite satisfactory intermediate limb salvage and patency rates. However, close graft surveillance and prompt intervention are required to avoid graft failure.     

Preliminary experience of angioscopy in femorodistal bypass.

During femorodistal bypass angioscopy can be used in vein graft preparation allowing valve lysis and the identification of tributaries under direct vision. A total of 30 patients have undergone angioscopic assisted femorodistal bypass using either an Olympus or Stortz system. Nineteen patients have undergone full vein mobilisation and valve lysis under direct vision. Eleven patients had in situ bypass with ligation of tributaries, identified by the angioscope, through small stab incisions. No evidence of fistula or retained valve cusps was found by subsequent duplex scanning and arteriography. One of these grafts failed at 6 days due to an unrecognised outflow stenosis. The mean hospital stay after operation for this latter group of patients was 5.2 days (range 4.4-6.0 days) compared with 9.5 days (8.6-10.3 days) in a historical group of 30 patients (P < 0.001). Angioscopy is a useful aid in the performance of femorodistal bypass. Early experience suggests that hospital stay may be reduced by angioscope assisted in situ femorodistal bypass because of the minimal dissection involved.     

Wound-healing disturbances after vein harvesting for CABG: a randomized trial to compare the minimally invasive direct vision and traditional approaches

Background. Harvesting the great saphenous vein for coronary artery bypass grafting is often associated with complications in wound healing, insufficient cosmetic results, and delay in mobilization of the patients. The aim of this study was to compare the results of our minimally invasive technique with the traditional method.

Methods. We report our experience of minimally invasive direct vision harvesting the great saphenous vein with the Aesculap retractor system (Aesculap AG Co KG, Tutlingen, Germany) by performing 3 (to 5) small cutaneous incisions. We scheduled 255 patients for elective coronary artery bypass grafting prospectively randomized to undergo vein harvesting by either the minimally invasive technique (group A: n = 128; age range, 68.2 ± 9.1 years; male, 53.1%) or by the traditional technique (group B; n = 127; age range, 66.1 ± 8.3 years; male, 62.9%). We classified and defined leg-wound healing disorders in terms of mild, moderate, and severe wound-healing disturbances.

Results. Between group A and B there were no differences with the risk stratification before operation, length of vein being harvested, or total operation time. The time for minimally invasive harvesting of the great saphenous vein was slightly increased. Severe leg-wound healing disorders occurred in 4 of 128 patients of group A (3.1%) versus 12 of 127 patients of group B (9.4%) with significant difference (p = 0.042).

Conclusions. Minimally invasive direct vision harvesting the great saphenous vein is an attractive alternative to the traditional open-harvesting technique. In our trial this procedure resulted in fewer wound complications and showed a much better cosmetic outcome. The total operation time was not increased by using the minimally invasive technique.     

A quick and atraumatic method of autologous vein harvesting using the subcutaneous extraluminal dissector

Subcutaneous harvesting using an extraluminal vein dissector was used to obtain saphenous and cephalic veins for aortocoronary vein bypass grafting (CVBG) in 428 unselected consecutive patients without complications. The operative technique is simple, quick and easy to learn. Advantages of the method include expeditious harvesting, limited tissue dissection and vein handling, with minimal overt and occult blood loss. Symptomatic benefits include a considerable reduction of leg wound infection (3% superficial inflammation), comfort and improved early mobility. Reduction in late morbidity due to saphenous nerve damage (1.6%), prolonged oedema (0.7%), and delayed sinus formation were also noticeable features. Light and Scanning Electron Microscope (SEM) studies of 57 vein samples showed no excessive trauma to the vein wall but more specifically no evidence of distraction injury to the tributaries when compared with the more traditional dissection technique.     

"No-touch" technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium

Spasm and consequent dilation of the saphenous vein (SV) for coronary artery bypass grafting (CABG) can be avoided if the vein is harvested with its surrounding tissue. Morphologic techniques, including scanning and transmission electron microscopy, were used to compare endothelial cell integrity using three SV harvesting procedures: conventional (adventitial stripping of the vein, manual distention and storing in saline); intermediate (after adventitial stripping, the vein was left in situ, covered with a papaverine-soaked compress, and stored in heparinized blood); and "no-touch" (SV dissected with its surrounding tissue was left in situ, covered with a saline-soaked compress and stored in heparinized blood). Preservation of endothelial cell integrity was greater with the "no-touch" procedure than with the other methods. Since endothelial cell integrity of SV grafts may affect the patency rate, we conclude that the "no-touch" preparation should improve the results of CABG.     

Natural history of infrainguinal vein graft stenosis relative to bypass grafting technique

Purpose: To determine whether the incidence of vein graft stenosis is related to bypass grafting technique and thus modification of postoperative surveillance protocols may be required.Methods: From 1991 to 1996, 338 infrainguinal vein bypasses constructed using in situ (n = 131), reversed (n = 120), nonreversed translocated (n = 48), or spliced/upper extremity vein (n = 39) grafting techniques were evaluated by intraoperative duplex scanning to optimize bypass construction and serially thereafter to detect developing vein graft stenoses. Bypass procedures were performed in 322 patients for critical limb ischemia (83%), claudication (13%), or popliteal aneurysm (4%). Using life-table analysis, graft patency and revision/failure rates were compared relative to grafting technique, need for operative revision, and intraoperative duplex scan results.Results: Three-year primary and secondary graft patency rates were higher (p < 0.001) for in situ bypass grafts (85%/97%) compared with reversed (57%/83%), nonreversed translocated (62%/78%), or alternative (51%/76%) vein bypass grafts. During a mean follow-up interval of 19 months, the incidence of graft revision was higher for reversed saphenous (23%) and alternative (28%) vein bypass grafts compared with in situ (10%) or nonreversed (16%) saphenous vein bypass grafts. Despite a normal intraoperative graft duplex scan, the revision/failure rate of reversed vein grafts was 2.5 times greater than in situ/nonreversed translocated vein conduits (primary patency rate at 3 years, 60% vs 87%, p = 0.009). Bypass grafts modified at operation on the basis of duplex scanning were two times more likely to require postoperative revision than grafts with normal intraoperative scans.Conclusions: The incidence of postoperative graft stenosis and need for revision varies with bypass grafting technique. Reversed vein bypasses and grafts modified at operation may be more prone than in situ vein bypass grafts to develop stenosis and thus require intensive surveillance. Infrainguinal vein graft failure and the need for revision may be reduced by the adoption of bypass grafting techniques that include valve lysis and intraoperative duplex scan assessment. (J Vasc Surg 1997;25:211-25.)     

注射毒品所致假性股动脉瘤18例的外科治疗

目的 探讨注射毒品所致假性股动脉瘤的外科疗法。方法 对18例注射毒品所致辞假性动脉瘤患者的临床资料进行回顾分析。13例直接采用ePTFE人工血管行旁路髂外动脉和股浅动脉端侧吻合术；3例采用自体大隐静脉间置移植术，其中１例吻合口破裂出血改用ePTFE人工血管行旁路髂外动脉和股浅端侧吻合术；2例股动脉结扎术。结果 全部病例保肢成功。血管移植术后复查彩色多普勒超声显示移植血管通畅。结论 在患者不能提供合适的自体大隐静脉移植时，人工血管移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及避免污染是预防术后人工血管并发感染的最主要措施     

Breast reduction surgery after coronary artery bypass grafting

Breast reduction surgery is a frequently performed procedure. Older patients presenting for this surgery may have previously undergone coronary artery bypass grafting with harvesting of one or both internal mammary arteries. This may compromise the blood supply to the breast. Limiting medial dissection during breast reduction surgery in these women is prudent to prevent breast necrosis. A case illustrating this is described.     

The durability of endoscopic saphenous vein grafts: a 5-year observational study

BACKGROUND: Endoscopic saphenous vein harvest has been explored as a minimally invasive alternative to a long continuous leg incision for removal of the greater saphenous vein. The endoscopic technique uses limited incisions (2-4) with extended "skin bridges" and videoscopic equipment for the dissection and removal of the greater saphenous vein. This study was undertaken to evaluate the long-term durability of saphenous vein grafts harvested by an endoscopic technique and used for lower extremity arterial revascularization. METHODS: All patients who underwent endoscopic saphenous vein harvesting for lower extremity arterial bypass grafting were prospectively followed for graft patency and risk factors. Grafts were surveyed with serial duplex scans at 3- to 6-month intervals over this 5-year study. Life-table methods were used to assess graft survival. A computerized registry and medical records were reviewed to determine graft patency and patient survival. RESULTS: From September 1994 to August 2000, 164 lower extremity arterial saphenous vein grafts harvested by an endoscopic technique were used for lower extremity arterial bypass grafting in 150 patients. The patient population included 111 males (75%) and 112 smokers (75%), but also included a high-risk cohort of 65 diabetic patients (43%) and 15 patients undergoing dialysis/renal transplant (10%). Twenty-eight patients (19%) died within the study period. With life-table methods, 1-, 3-, and 5-year secondary patency rates were 85% (+/- 3.2%), 74% (+/- 5.7%), and 68% (+/- 11.6%). Of the 30 failed grafts, 7 (4%) failed in the first month related to inadequate runoff (4), cardiac instability (2), and an additional surgical procedure (1). Twenty-three grafts (14%) failed between 1 and 42 months. Twenty-two (16%) of these 134 patent grafts underwent a second procedure to maintain patency (13 as primary-assisted patency and 9 as secondary patency). CONCLUSIONS: Endoscopic saphenous vein harvest for lower extremity arterial reconstruction provides a satisfactory conduit for lower extremity bypass grafting. Although increased manipulation from this limited access technique may incite an injury response in the vein, these vein grafts can maintain an adequate patency for lower extremity bypass grafting.     

Surgical results of video-assisted minimally invasive direct coronary artery bypass.

BACKGROUND: A video-assisted minimally invasive direct coronary artery bypass procedure is defined as a combination of video thoracoscopic internal mammary artery harvest and direct coronary bypass grafting through a minithoracotomy without cardiopulmonary bypass. We reviewed our experience with this procedure and examined its efficacy. METHODS: Since November 1995, 110 patients have undergone a minimally invasive direct coronary artery bypass procedure in our institution. Seventy (64%) of them underwent a video-assisted minimally invasive operation (group 1). As a control group (group 2), we reviewed the results in 37 patients who underwent conventional single or double coronary artery bypass grafting using an internal mammary artery graft between 1993 and 1995 and could have been candidates for minimally invasive direct coronary artery bypass grafting. RESULTS: There were two hospital deaths (2.9%) in group 1 and one hospital death (2.7%) in group 2. There were no significant differences in mortality or morbidity between the two groups. The number of patients who needed postoperative positive inotropic agents was significantly greater in group 2, and this group also had a significantly longer mean postoperative intubation time and mean hospital stay than group 1. CONCLUSIONS: The surgical results of video-assisted direct coronary artery bypass procedures were better than those of conventional coronary artery bypass grafting in this review. A long-term follow-up for graft patency is needed.     

Do residual arteriovenous fistulae after in situ saphenous vein bypass grafting influence patency?

PURPOSE: The purpose of this study was to evaluate the influence on patency of residual arteriovenous fistulae (AVF) after in situ saphenous vein bypass grafting. METHODS: Between January 1, 1994, and December 31, 1996, 98 in situ saphenous vein bypass grafting procedures were performed in 94 patients. Patency was evaluated with duplex scanning after operation and at 1, 3, 6, 9, and 12 months. RESULTS: The indications for operation were intermittent claudication in two patients and critical leg ischemia in 92 patients. Two above-knee and 48 below-knee femoropopliteal and 48 femorocrural in situ saphenous vein bypass grafting procedures were performed. The median follow-up period was 9 months (range, 1.5 to 12.5 months). There were no residual AVF in 45 veins (44%; group 1), but 110 residual AVF were found in 53 veins (56%; group 2). In group 2, 36 AVF in 18 veins were surgically or radiologically occluded mainly as a result of a flow velocity decrease distal to the AVF, but the remaining 74 AVF were treated conservatively. The 1-year cumulative primary patency rates were 68% in group 1 and 74% in group 2 (log-rank test, 0.47; degree of freedom = 1; P =.52). The 1-year cumulative assisted primary patency rates were 68% in group 1 and 81% in group 2 (log-rank test, 2.19; degree of freedom = 1; P =. 14). CONCLUSION: Residual AVF after in situ bypass grafting without influence on bypass graft hemodynamics do not compromise patency and thrombose spontaneously.     

Minimally invasive internal thoracic artery harvest: the hybrid approach

BACKGROUND: Safe harvesting of the left internal thoracic artery is a difficult problem during minimally invasive coronary artery bypass grafting without cardiopulmonary bypass. A complete internal thoracic artery dissection through a limited approach is technically demanding and time consuming and different techniques have been proposed. METHODS AND RESULTS: Based on our experience, the different surgical approaches and technical considerations are reviewed. CONCLUSIONS: A hybrid technique using dissection under direct vision and completed by thoracoscopy is discussed and proposed as our preferred technique of internal thoracic artery harvesting.     

Important anatomical and physiological considerations in performance of complex mammary-coronary artery operations

One or more internal mammary artery (IMA) anastomoses were performed in 87% of 692 consecutive coronary artery bypass operations performed over a 20-month period. One IMA was used in 68% (N = 469) and both IMAs were used in 19% (N = 130). Only saphenous vein grafts were used in 13% (N = 93). The mean number of anastomoses (all types) was 3.5. Fifty-seven patients were having a reoperation; bilateral IMA grafting was performed in 23% (N = 13). In 60 patients, 3 or more IMA anastomoses were performed: 3 IMA anastomoses, 50 patients; 4, 9 patients; and 5, 1 patient. In 27 patients, repeat coronary arteriography was performed within 30 days of operation to evaluate dynamics of IMA, saphenous vein, and native coronary artery flow. Major flow or all flow was through the graft (vs. the native coronary artery) in 62% of in situ IMA bypass grafts, 86% of free IMA grafts and 94% of saphenous vein grafts. Hospital mortality excluding patients having reoperation was 1.7% (11/635); it was less than 1% for patients having either single IMA grafting procedures (4/437) or bilateral IMA grafting procedures (1/117). Hospital mortality for patients receiving only saphenous vein grafts was surprisingly high, 7.4% (6/81). Major determinants of flow through the in situ IMA sequential graft are the size and flow of the IMA, the degree of proximal native coronary artery narrowing, the distally grafted to proximally grafted coronary artery size ratio, and probably the size of the side-to-side anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early results of a prospective randomized trial of spliced vein versus polytetrafluoroethylene graft with a distal vein cuff for limb-threatening ischemia

OBJECTIVE: Single-piece vein remains the conduit of choice in patients who need bypass grafting for limb salvage. When this option is not available, two of the remaining options are prosthetic bypass graft or several segments of vein spliced together. In this study, we compare spliced vein bypass grafting versus polytetrafluoroethylene grafting with a distal vein cuff in patients with limb-threatening ischemia. METHODS: Between 1996 and 2000, 39 bypass grafting procedures in 36 patients were performed for limb-threatening ischemia. These procedures were prospectively randomized to either spliced vein bypass grafting (spliced group, 19 bypass grafts) or polytetrafluoroethylene grafting with a distal vein cuff (cuff group, 20 bypass grafts). All the patients in the cuff group underwent anticoagulation therapy with warfarin sodium after surgery. The inclusion criteria included: no single-piece vein option for bypass grafting, adequate vein for splice, no composite sequential option, and limb-threatening ischemia. The demographics were similar between the two groups. RESULTS: The primary patency rate at 2 years was 44% and 49% for the spliced and cuff groups, respectively. In the spliced group, seven of 19 bypass grafts underwent revision in the follow-up period, and two of 20 cuffed bypass grafts were successfully revised. The secondary patency rate was 87% and 59% (P <.05), with limb salvage rates of 94% and 85% for spliced and cuff groups, respectively. Four patients in the spliced vein group needed reoperation for wound complications related to vein harvest. One polytetrafluoroethylene graft needed removal for infection. Two early mortalities occurred in the spliced group, one from myocardial infarction and one from stroke. The overall survival rate at 2 years between the two groups was 67% and 100% for the spliced and cuff groups, respectively (P <.05). CONCLUSION: Although this is a preliminary report, it appears that both spliced vein bypass grafting and polytetrafluoroethylene bypass grafting with a distal vein cuff produce acceptable limb salvage rates. The secondary patency rate for spliced vein is better, but these bypass grafts more often need revision or reoperation for wound complications.     

Relief of compromised translocated right coronary artery blood flow by clockwise rotation of the heart in a Jatene procedure

Saphenous vein graft pseudoaneurysms are an unusual but potentially fatal complication of coronary artery bypass grafting because of their high risk of rupture or thromboembolism. We experienced the case of a 58-year-old man with a saphenous vein graft pseudoaneurysm with a floating thrombus that had developed 17 years after the initial coronary artery bypass grafting. The prevention of thromboembolism during a surgical procedure has been crucial for this type of operation. We developed the idea of in situ revascularization using the right gastroepiploic artery under the beating heart on cardiopulmonary bypass followed by an aneurysmectomy under an arrested heart.     

In situ tibial reconstruction. State-of-the-art or passing fancy.

To further evaluate the efficacy of in situ saphenous vein bypass, the authors have reviewed their experience with in situ bypass. Between October 1981 and December 1985, 120 in situ saphenous vein bypass were performed; 81 were to infrapopliteal vessels. All procedures were performed for limb salvage. The mean patient age was 74 years, and 74% were men, 57% had diabetes mellitus, 92% were smokers, and 72% had hypertension and/or coronary artery disease. All patients were evaluated by preoperative noninvasive testing and biplanar angiography. All procedures were performed by the valve incision technique. The vein utilization rate was 91%. Grafts were routinely placed into isolated tibial segments and foot vessels without evidence of a patent pedal arch. Follow-up information was obtained at 3-month intervals. Patency and limb salvage data were calculated by life-table analysis. The cumulative patency rates were 98% at 1 month, 88% at 12 months, and 82% at 50 months. These data demonstrate that the in situ bypass maintains an excellent patency rate and provides durable limb salvage.     

Endoscopic saphenous vein harvesting: initial experience and learning curve

BACKGROUND: Saphenous vein remains an elective conduit for up to 85% of coronary bypass operations. It is obtained through one or numerous skin incisions, with a reported morbidity varying from 5% to 25%. The endoscopic vein harvesting (EVH) technique was developed to minimize this morbidity and to improve clinical outcomes. The aim of this study was to review the feasibility of this method, its learning curve, and changing results in a group without previous experience in this procedure. METHODS: Between July 1998 and October 1999, 179 patients for coronary artery bypass grafting underwent EVH (Vasoview Guidant, USA "double access" and Uniport), by two operators. Results were reported based on time of harvesting, length of conduits, technical details, and clinical outcomes, and divided into six groups of 30 consecutive patients each. RESULTS: Patient demographics were as follows: 86.03% were male, aged 64.3+/-9.12 years (range, 43 to 92 years), with diabetes mellitus in 28.49%, obesity in 18.43%, and vascular disease in 11.17%. The EVH method was limited to the thigh in 77.65% of cases and extended to the leg in 22.35%. Patients received an average of 2.45+/-0.58 incisions and obtained conduits had a mean length of 34.96+/-9.65 cm (range, 15 to 70 cm). The number of venous bypasses per patient was 1.30+/-0.59. Mean time of EVH was 47.24+/-19.84 minutes (range, 15 to 120), with a length-time index of 0.85+/-0.36. Primary success was achieved in 95.54%, with crossover to open technique in 4.46%. General morbidity was 8.9%, with hematoma in 1.11%, skin necrosis in 1.11%, infection in 6.7%, and readmission in 1.11%. CONCLUSIONS: Endoscopic vein harvesting is a feasible and reproducible method, with a typical learning curve, acceptable morbidity, and unquestionable benefits for coronary artery bypass graft patients.