Why the study?
Saphenous vein harvesting techniques in coronary bypass surgery balance trade-offs between graft patency and wound complications, prompting interest in endoscopic methods that remove the vein intact with minimal vascular damage.
Does endoscopic no-touch saphenous vein graft harvesting improve graft patency and reduce wound complications compared to conventional methods in patients undergoing coronary bypass surgery?
Does endoscopic no-touch saphenous vein graft harvesting improve graft patency and reduce wound complications compared to conventional methods in patients undergoing coronary bypass surgery?
Endoscopic no-touch saphenous vein harvesting may offer the dual benefits of superior graft patency and reduced wound complications in CABG, though clinical patency data are still needed.
Conventional saphenous vein harvest may impair patency; leaves open whether no-touch or endoscopic techniques improve CABG outcomes.
The saphenous vein is the most used conduit for coronary artery bypass surgery. However, the patency rate of this graft is inferior to the internal thoracic artery patency rate, which is the gold standard. Using the conventional technique, the saphenous vein is harvested via a large open incision and excised in such a way that causes both vascular damage and wound healing complications. Consequently, vein graft patency and surgical site infection may be compromised. Graft patency is markedly improved when the saphenous vein is harvested atraumatically with minimal damage and with surrounding cushion of perivascular fat intact. However, despite the improved graft performance, wound healing complications and infection remain a problem. Although wound healing complication is reduced when using endoscopic vein harvesting, there may be a negative impact on graft performance. This is due to vascular damage associated with application of forces to the vein that are usually avoided in open vein harvesting, including traction, adventitial stripping, and venous compression. There is evidence to suggest that improved patency of endoscopically harvested saphenous veins is associated with the surgeon's experience of the technique. Recently, endoscopic methods of harvesting have been described where the saphenous vein is removed intact and with minimal vascular damage caused. In addition, wound healing complications, infection, and scarring are reduced. While the effect of these techniques on vein graft patency have yet to be reported, the ability to obtain a superior graft with reduced wound complications will be of great benefit to patients undergoing coronary revascularization procedures.
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Kopjar et al. (2022) studied this question.
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