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European Surgery

, Volume 39, Issue 2, pp 96–104 | Cite as

Endoscopic vein harvesting in coronary artery bypass surgery

  • S. HuberEmail author
  • P. Bergmann
  • S. Schweiger
  • H. Mächler
  • P. Oberwalder
  • B. Rigler
Main Topic
  • 62 Downloads

Summary

BACKGROUND: Leg wound complications and infections after harvesting of the greater saphenous vein (GSV) in coronary artery bypass surgery (CABG) represent a serious source of patient morbidity. Especially, in patients with obesity, diabetes and peripheral vascular disease, severe wound complications with increased pain occur more often. METHODS: Our aim was to evaluate the feasibility and the results of the endoscopic saphenous vein harvesting. From October 2002 until November 2005, in 63 patients with coronary artery disease, scheduled for elective CABG surgery, endoscopic vein harvesting (EVH) was performed using the Guidant VasoView® System. We investigated harvesting time and preparation time for the vein, intraoperative complications and conversion to traditional open harvesting, quality of the harvested vein including number of repairs needed, flow rates of the bypass grafts and postoperative wound related complications. RESULTS: The mean harvesting time was 37.5 min (19–72 min). Four patients had to be converted to the open harvesting technique because of bleeding and massive build up of fatty tissue inside the preparation tunnel. The quality of the harvested veins was assessed with a score of 1.4 on a scale ranging from 1 to 5. Side branches were either ligated or clipped. Small holes tears not suitable for tying were repaired with a prolene suture. The mean number of repairs was 1.4. In one patient, the wall of the endoscopically harvested vein was too thin and varicose, so that the vein was not suited to be used as a bypass graft. In 17 patients (29%) the EVH vein was needed for only one graft, in 37 patients (64%) the harvested vein was used for 2 grafts, and in 4 patients (7%) for 3 grafts. The mean flow rate of the EVH grafts was 50 ml/min (10–159 ml/min). Postoperatively, 22 patients (37%) had hematomas along the course of the preparation tunnel. These hematomas, however, had diminished at the time of discharge. There were no leg wound complications or infections. CONCLUSIONS: The advantages of EVH are the reduced trauma to the leg and the painless and faster mobilization of the patients. The harvesting time is acceptable despite a learning curve. The operative time is not prolonged. The visualisation of the EVH system is excellent and the handling can be adopted easily. The quality of the endoscopically harvested veins is equal to an open harvest technique, with the advantages of less postoperative pain and a better cosmetic result. The conversion rate is low (4 of 63). Postoperative wound complications are not to be expected.

Keywords

Endoscopic vein harvesting Coronary artery bypass surgery 

Endoskopische Venenentnahme für aortokoronare Bypassoperationen

Zusammenfassung

GRUNDLAGEN: Wundheilungsstörungen und Wundinfektionen am Bein nach Entnahme der Vena saphena magna (VSM) für aorto-coronare Bypassoperationen (CABG) stellen eine schwerwiegende Komplikation dar. Speziell bei Patienten mit Adipositas, Diabetes mellitus und peripheren Durchblutungsstörungen treten vermehrt tiefreichende Wundheilungsstörungen 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 Präparationszeit der Vene, intraoperative Komplikationen und Konversion zur offenen Entnahmetechnik, Qualität der entnommen Vene und Anzahl an Reparaturnähten, Flowwerte der eingesetzten Venengrafts und postoperative Wundkomplikationen. ERGEBNISSE: Die mittlere Entnahmezeit betrug 37,5 min (19–72 min). Aufgrund von Blutungen und Fettgewebsansammlungen im Präparationskanal musste bei 4 Patienten zur offenen Entnahmetechnik konvertiert werden. Die Qualität der präparierten Venen wurde mit einem Score von 1,4 auf einer Skala von 1–5 beurteilt. Die Seitenäste wurden ligiert und geklippt, im Mittel mussten 1,4 Löcher pro Vene von ausgerissenen Seitenästen mit Prolene übernäht werden. Bei einer Patientin war die Wand der endoskopisch entnommenen VSM zu dünn und varikös, sodass die Vene nicht als Bypassgraft verwendet werden konnte. Bei 17 Patienten (29%) wurde aus der endoskopisch präparierten 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 Hämatome entlang des Präparationskanals auf, die bei Entlassung gänzlich zurückgegangen waren. Wundheilungsstörungen 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 Präparationszeit der Vene ist trotz "learning curve" akzeptabel. Die Operationszeit wird nicht verzögert. Die Visualisierung ist ausgezeichnet und die Handhabung des Systems ist schnell erlernbar. Die präparierten Venen sind mit dieser Entnahmetechnik den konventionell offen entnommenen Venen ebenbürtig, 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.

Schlüsselwörter

Endoskopische Venenentnahme Aortokoronare Bypassoperationen 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • S. Huber
    • 1
    Email author
  • P. Bergmann
    • 1
  • S. Schweiger
    • 1
  • H. Mächler
    • 1
  • P. Oberwalder
    • 1
  • B. Rigler
    • 1
  1. 1.Division of Cardiac Surgery, Department of SurgeryMedical University of GrazGrazAustria

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