Quantification of thermal spread and burst pressure after endoscopic vessel harvesting: a comparison of 2 commercially available devices.
OBJECTIVE
Endoscopic vein harvesting systems have grown in popularity and are becoming the gold standard for coronary artery bypass grafting. Although a consensus is present that endoscopic vessel harvesting minimizes wound complications, long-term graft patency remains a concern. It has been proposed that endoscopic vessel harvesting affects graft patency because of irreversible trauma to the endothelium. This study was performed to examine the extent of thermal injury caused by 2 commercially available endoscopic vessel harvesting systems in a porcine model.


METHODS
Superficial epigastric veins and saphenous arteries were exposed in 10 anesthetized swine. All vessel samples (conduits) were harvested randomly with either a VirtuoSaph (Terumo Cardiovascular, Ann Arbor, Mich) or VASOVIEW 6 (MAQUET, Inc, Wayne, NJ) endoscopic vessel harvesting system. Conduits were harvested and saved for either histologic analysis or burst-pressure test. Statistical differences were analyzed by using a Wilcoxon rank sum test in SAS 9.2 software (SAS Institute, Inc, Cary, NC) for thermal spread and a 2-tailed t test with equal variance for burst pressure.


RESULTS
The average thermal spreads for saphenous artery and superficial epigastric vein conduits were significantly shorter in the VirtuoSaph group (0.42 ± 0.08 and 0.49 ± 0.05 mm, respectively) than in the VASOVIEW 6 group (1.05 ± .04 and 0.94 ± 0.19 mm, respectively). No significant differences were observed in burst pressure.


CONCLUSIONS
The length of thermal spread is short in arterial and venous conduits (0.4-1.1 mm) and depends on the endoscopic vessel harvesting system. Clinical protocols should include a minimal length of the cauterized branch to ensure that thermal spread does not reach the main vessel. The results of this study suggest that at least 1 mm is sufficient.
General Surgery Department, ECMO Laboratory, University of Michigan Health System, Ann Arbor, Mich 48109, USA. alvaror@umich.edu
Alvaro
A
Rojas-Pena
Kelly L
KL
Koch
Holden D
HD
Heitner
Candice M
CM
Hall
Ingrid L
IL
Bergin
Keith E
KE
Cook
D000009:Abdominal Muscles / Q000098:blood supply*; D000818:Animals; D001158:Arteries / Q000293:injuries / Q000637:transplantation; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000473:pathology; D035002:Lower Extremity / Q000098:blood supply*; D008422:Materials Testing; D023421:Models, Animal; D011312:Pressure; D013552:Swine; D020858:Tissue and Organ Harvesting / Q000295:instrumentation*; D014654:Vascular Patency; D057772:Vascular System Injuries / Q000209:etiology / Q000473:pathology; D014680:Veins / Q000293:injuries / Q000637:transplantation