Endoscopic vein harvest: advantages and limitations

BACKGROUND: Although long saphenous vein remains the most commonly used conduit in coronary revascularization, traditional open vein harvest (OVH) may lead to significantly impaired wound healing and postoperative pain. Endoscopic vein harvest (EVH) attempts to reduce this morbidity and improve patient satisfaction with no compromise in outcome. METHODS: From September 2000 to November 2001, 108 saphenous vein harvests were prospectively randomly assigned to EVH (n = 52) or OVH (n = 56); EVH was performed with the Clearglide endoscopic vein harvest system (Cardiovations) by a single surgeon. Endpoints included impaired wound healing (ASEPSIS score), operative and harvest time, vein quality (including histology), outcome and postoperative pain (Visual Analog Scale). Follow-up was as long as 3 years. RESULTS: The groups were well matched demographically. Endoscopic vein harvest was quicker to perform if sufficient vein for two grafts was needed (p < 0.01). Wound healing was significantly impaired (ASEPSIS score) in the OVH group compared with the EVH group (p < 0.01). The new procedure did not prolong the overall operative time (p = 0.77). Postoperative pain was less (p < 0.01) in the EVH group. Stepwise multiple regression showed age, diabetes, peripheral vascular disease, total operative time, type of procedure, length of incision, and number of vein grafts to be predictive of impaired wound healing. More late interventions were needed in the OVH group for wound-related morbidity. CONCLUSIONS: These data demonstrate that endoscopic vein harvest results in fewer cases of impaired wound healing and reduced postoperative pain, and it does not prolong the operative time significantly nor compromise the vein quality. Furthermore, it is quicker to perform if two grafts are needed, and it reduces late interventions.