Minimally invasive saphenous vein harvesting guided by preoperative echotomography: results of a prospective randomized study

Abstract

Morbidity related to impaired leg wound healing after GSV harvest is a neglected problem with inherent social costs. We developed a minimally invasive harvest (MIH) technique without the need of specific devices guided by preoperative echotomography. We tested it in comparison to open harvest in a prospective, randomized study. One hundred and seven patients were prospectively randomized to receive either MI or conventional (C) harvest. Preoperative Doppler echotomography was performed in order to identify vein segments suitable for CABG and surgically attainable. Multiple skin incisions (up to four per patient and each one up to 5 cm in length) parallel to the vein axis were performed. MI had no adverse effects on graft function and associated to higher graft blood flow after anastomosis, probably due to reduced venospasm. MI was more time-expensive, but resulted in a significantly lower incidence of postoperative wound morbidity. This was particularly evident in patients with risk factors for wound complications. The MI approach is safe and reliable for obtaining venous conduits for CABG. Accurate echotomography mapping of the leg veins is pivotal for its efficacy. Given the low costs and evident benefits, MIH should be tested as an alternative approach in the routine surgical practice.