Endoscopic Vein Harvesting in CABG Surgery an Initial Iranian Experience

Background:the minimally invasive endoscopic dissection of vessel conduits is steadily gaining acceptance as a preferable alternative to the standard open-incision technique. . As experience and refinements in instrumentation progress, the endoscopic approach will undoubtedly become the procedure of choice for harvesting vessel conduits. This article provides a practical primer, based on our serial experience with endoscopic vein dissections, for those considering the minimally invasive endoscopic approach inharvesting vessels for CABG.Methods: Video-assisted endoscopic technique for vein harvest was introduced in our medical center in august 2007. The procedure was evaluated and compared with the standard open vein harvest procedure with regard to primary short - term outcomes:1) leg wound complications (identified as dehiscence, drainage for greater than 2 weeks postoperatively, cellulitis, hematoma, and seroma/lymphocele and neurologic complications). 2) Short-term event free survival( focused on any cardiac events ,30 days after CABG) between August 2007 and May2008 .we prospectively randomized 150 patients scheduled for elective CABG to vein harvesting via EVH and OVH. We used ClearGlide vessel harvesting system, Datascope corp, to harvest the greater saphenous vein .The groups were similar with regard to age, risks for wound complications (diabetes,sex,obesity,peripheral vascular disease), bypass time, the length of vein harvested (EVH:40±15cm vs.OVH:45±15cm) p=0.65,and total number of grafts(168 vs 175)p =0.4 Results:we randomized 150 patients schaduled for elective CABG to vein harvesting via EVH(n=75) or OVH(n=75).Average operation time was177 min in OVH group.In EVH group operation time increased approximately 45 min ±20 for the first 50 cases,but later,it didn’t realy influence the time.. In EVH group 5 patients were converted to OVH due to anatomical or device issues.The prevalence of leg complications was 4% vs 18.6% for EVH and OVH groups respectively (p=0.007) ,and for local infection 0% vs 12% p 0.0001.Short term event-free survival(1mo follow up) is 94.7% vs 93.4% p=0.85. Conclusion:consistent with earlier findings ,wound complications and outpatient office visits to manage each complication ,was significantly reduced following EVH compared with OVH.The use of small access incisions and well-designed endoscopic instrumentation to harvest the saphenous vein would be expected to provide cosmetically superior outcomes compared with a single long ,open incision .This study also suggested that coduit quality ,may not differ as a result of the EVH technique.