Saphenous vein harvesting with endoscopy versus no-touch technique: short-term results

Rezumat

Objective ‘No-touch’ (NT) saphenous vein harvesting maintains vasa vasorum, resulting in less medial ischemic affection, which leads to improved short-term and long-term patency. However, it may also be associated with a higher rate of wound complications. Endovascular vein harvesting (EVH) has a low rate of wound complications but also a tendency toward a lower patency rate. The aim was to compare wound complications and short-term symptomatic relief, which could be an indication of functioning grafts. Patients and methods During a 2-year period (2018–2019), in a nonrandomized prospective study, we monitored patients after coronary artery bypass graft for recurrence of ischemic symptoms and wound complication rates in 100 patients who received either NT (53 patients) or endo-vein (47 patients). Results The recurrence symptom rate for both groups was similar: five (9.4%) of 53 patients of the NT patients versus four (8.1%) of 47 of the EVH patients. Among these patients, there was complete symptomatic relief by medical treatment in all except two patients in EVH group who underwent catheterization, where graft occlusion of OM and diagonal arteries was seen in one patient and the other showed graft occlusion of the diagonal artery. Operative time for harvesting the vein in EVH was significantly longer in EVH (6030 min) versus NT (3010 min). A comparison between a more experienced and a less experienced harvesting surgeon revealed no difference in the operative time. Harvest-site complications were significantly higher with the NT harvest: 19% of the NT patients, of them one patient required vacuum-assisted wound closure, versus 2% of the endo-vein patients. The rate of reopening for bleeding was significantly higher with the NT harvest (three patients) versus zero patient in EVH group. Conclusion These results suggest that NT vein harvesting may be associated with better symptomatic relief postoperatively, which might be an indication of improved graft patency, but methods should be developed to lower wound complication rates and pedicle hemostasis.