Zusammenfassung
Trotz der rasanten Entwicklungen in der Gefäßmedizin und Materialkunde in den letzten Jahrzehnten hat sich an der Tatsache nicht viel geändert, dass die Vene hinsichtlich Verträglichkeit und Offenheitstaten das beste Bypassmaterial ist. Neben der gelegentlich suboptimalen Venenqualität ist das Zugangstrauma zur Gewinnung der Vene ein in der klinischen Praxis zuweilen quälendes Problem, welches relevante Morbidität und, daraus resultierend, Kosten verursacht.
Minimal-invasive Entnahmemethoden der Vene sind in dieser Hinsicht eine vielversprechende Alternative zur konventionellen Venengewinnung. In der Kardiochirurgie ist die endoskopische Venenentnahme in der letzten Dekade zum Behandlungsstandard geworden. Daten für diese Methode sind in der Gefäßchirurgie nur spärlich und nicht im höchsten Evidenzgrad verfügbar. Die publizierten Daten deuten jedoch auf die Möglichkeit des klinischen benefits für Patienten durch den Einsatz von EVH hin. Damit ein sinnvoller und medizinisch zu rechtfertigender Einsatz in der Routine erfolgen kann, müssen gut geplante und gepowerte randomisierte Studien durchgeführt werden, um Populationen, die am meisten von der endoskopischen Venenentnahme profitieren, definieren zu können.
Abstract
Despite rapid developments in vascular medicine, venous conduits remain the gold standard regarding patency. The major problem in terms of morbidity and cost is exposure of the vein. In this respect, endoscopic vein harvesting (EVH) is an appealing method and is regarded as the standard of care in cardiac surgery. Data for peripheral bypass surgery are sparse and rarely of level-one evidence. However, published data indicate a benefit for patients, mainly regarding reduction of postoperative wound complications and thus costs. Yet to establish this method for routine use and to be able to define populations that may have the highest benefits from EVH, sufficiently powered and well-conducted trials are needed.
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Assadian, A. Endoskopische Venenentnahme in der Gefäßchirurgie. Gefässchirurgie 14, 485–489 (2009). https://doi.org/10.1007/s00772-009-0706-0
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DOI: https://doi.org/10.1007/s00772-009-0706-0