Less-invasive saphenous harvest.
Vascular and cardiovascular surgeons, having only recently been introduced to less-invasive techniques of saphenous vein harvest and in situ preparation, are embracing these new technologies with cautious enthusiasm. Although the available data are limited, with few prospective randomized trials, less-invasive methods of saphenous vein harvest seem to result in reduced wound complications, improved patient satisfaction, and decreased hospital LOS. The most important but least well defined variable is the effect of harvesting technique on graft patency. Concerns that excess traction and manipulation of the vein during less-invasive harvesting techniques may compromise patency have limited the wide adoption of these techniques. Although an increase in the need for vein repair with 7-0 sutures was reported in one series, limited histologic studies have not shown injury at the cellular level. Patency data for endovascular-assisted, less-invasive, in situ bypass procedures have demonstrated equivalent intermediate results, but less-invasive saphenous vein harvest has limited follow-up data available. Before these less-invasive techniques can be fully embraced, intermediate and long-term patency data must be critically analyzed. If the preliminary impressions of decreased morbidity and hospital LOS are supported by future trials, these savings will certainly eclipse the costs associated with prolonged operating room use and disposable instrumentation. The variety of instruments available and the preponderance of disposables in the market attest to the newness of the field. Although mechanical retraction devices predominate, carbon dioxide insufflation has been used successfully. As the techniques and instrumentation for saphenous harvest are refined, reusable instrumentation will likely play a more prominent role and result in additional cost savings.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. Mark.Iafrati@worldnet.att.net
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D000818:Animals; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001026:Coronary Artery Bypass; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*