Abstract
Conventional open harvest of the great saphenous vein (GSV) during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH) the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.
Highlights
The great saphenous vein (GSV) is the most commonly used conduit for coronary artery bypass grafting (CABG)
Since endoscopic vein harvesting (EVH) has reached an advanced stage of implementation, and has become accepted and by patients highly appreciated by part of standard care, thorough randomised evaluation has become more difficult
A moral obligation exists to ensure without any doubt safety and durability of the endoscopically harvested conduit, since conduit quality is likely to influence clinical outcome of CABG, the golden standard for a considerable portion of patients with multivessel coronary artery disease
Summary
The great saphenous vein (GSV) is the most commonly used conduit for coronary artery bypass grafting (CABG). Evaluation of 1577 patients that underwent open GSV harvest for CABG in Maastricht, revealed that in 1.5% of patients donor-site infections were diagnosed before discharge [1]. This figure increases to 4.6% at 30 days followup and 7.3% at 90 days followup. During EVH disposable or reusable systems are used to harvest approximately 35 cm of the upper leg GSV through a 3 cm incision on the medial side of the knee (Figure 1). In general one can expect a personal learning curve of 20–100 procedures, depending on surgical experience. An important preventive measure is reduction of the CO2 insufflation pressure, most importantly not allowing the CO2 pressure to surpass the central venous pressure
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