Endoscopic saphenous vein harvesting: initial experience and learning curve.
BACKGROUND
Saphenous vein remains an elective conduit for up to 85% of coronary bypass operations. It is obtained through one or numerous skin incisions, with a reported morbidity varying from 5% to 25%. The endoscopic vein harvesting (EVH) technique was developed to minimize this morbidity and to improve clinical outcomes. The aim of this study was to review the feasibility of this method, its learning curve, and changing results in a group without previous experience in this procedure.


METHODS
Between July 1998 and October 1999, 179 patients for coronary artery bypass grafting underwent EVH (Vasoview Guidant, USA "double access" and Uniport), by two operators. Results were reported based on time of harvesting, length of conduits, technical details, and clinical outcomes, and divided into six groups of 30 consecutive patients each.


RESULTS
Patient demographics were as follows: 86.03% were male, aged 64.3+/-9.12 years (range, 43 to 92 years), with diabetes mellitus in 28.49%, obesity in 18.43%, and vascular disease in 11.17%. The EVH method was limited to the thigh in 77.65% of cases and extended to the leg in 22.35%. Patients received an average of 2.45+/-0.58 incisions and obtained conduits had a mean length of 34.96+/-9.65 cm (range, 15 to 70 cm). The number of venous bypasses per patient was 1.30+/-0.59. Mean time of EVH was 47.24+/-19.84 minutes (range, 15 to 120), with a length-time index of 0.85+/-0.36. Primary success was achieved in 95.54%, with crossover to open technique in 4.46%. General morbidity was 8.9%, with hematoma in 1.11%, skin necrosis in 1.11%, infection in 6.7%, and readmission in 1.11%.


CONCLUSIONS
Endoscopic vein harvesting is a feasible and reproducible method, with a typical learning curve, acceptable morbidity, and unquestionable benefits for coronary artery bypass graft patients.
Vrancic
J M
JM
Department of Cardiovascular Surgery, Instituto Cardiovascular de Buenos Aires, Argentina. don@lvd.com.ar
Piccinini
F
F
Vaccarino
G
G
Iparraguirre
E
E
Albertal
J
J
Navia
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D048909:Diabetes Complications; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009765:Obesity / Q000150:complications; D012501:Saphenous Vein / Q000601:surgery*; D014652:Vascular Diseases / Q000150:complications