Evaluation of less invasive method for saphenous vein harvest in patients with type II diabetes.
BACKGROUND
Diabetes mellitus is an established risk factor for leg wound healing complications after great saphenous vein harvest. Leg healing complications occur in 1-25% of coronary artery bypass graft patients, and are often underestimated.


METHODS
The records of 230 patients enrolled in a prospective trial to evaluate a minimally invasive approach compared with conventional longitudinal harvest were reviewed. Of 100 patients with diabetes, 49 had undergone minimally invasive harvest (group A). Forty-nine patients from the pool without diabetes who underwent minimally invasive harvest were selected using propensity scoring analysis (group B), and 46 diabetic patients operated using a conventional technique (group C) were matched to group A patients. Ninety-five patients with and 49 without diabetes finally entered the study. The quality of leg wound healing was quantified by ASEPSIS score by two independent surgeons in a blinded manner. The occurrence of complications was compared between groups.


RESULTS
Fewer leg wound healing complications occurred in diabetic patients in the minimally invasive compared with the conventional group (P < 0.0001). Rates of complications were comparable among diabetic and non-diabetic patients operated using the minimally invasive technique. The intraoperative flow of vein grafts obtained by the minimally invasive technique was comparable to that of veins harvested using the conventional technique.


CONCLUSIONS
These data suggest that postoperative leg wound morbidity can be significantly attenuated by the adoption of a less invasive approach, even in high-risk patients with diabetes. The advantages are not offset by the co-existence of other cardiovascular risk factors or by a long history of diabetes.
Nasso
Giuseppe
G
Division of Cardiac Surgery, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, Loc. Tappino, Campobasso, Italy. gnasso@libero.it
Anselmi
Amedeo
A
De Filippo
Carlo Maria
CM
Modugno
Pietro
P
Canosa
Carlo
C
Spatuzza
Paola
P
Testa
Nicola
N
Guerrieri
Massimiliano Walter
MW
Calvo
Eugenio
E
Alessandrini
Francesco
F
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007866:Leg / Q000502:physiology / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D012501:Saphenous Vein / Q000502:physiology / Q000637:transplantation*; D013530:Surgical Wound Infection / Q000382:microbiology; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014945:Wound Healing / Q000502:physiology*