Comparative results of endoscopic and open methods of vein harvesting for coronary artery bypass grafting: A prospective randomized parallel-group trial

Abstract

Background: We compared wound complications between endoscopic and open great saphenous vein harvesting for coronary artery bypass surgery. Methods: A total of 228 consecutive patients were prospectively randomized into two groups: open vein harvesting (OVH), 115 patients; and endoscopic vein harvesting (EVH), 113 patients. Each group was assessed for post-operative wound complications, pain intensity, and neuropathy in the early post-surgical period. Lymphoscintigraphy of the lower limbs as well as morphological studies of vein walls using light and electron scanning microscopy were performed. Results: Vein harvesting time was shorter for EVH than OVH: 31.8 ± 6.2min and 40.3 ± 15.8min, respectively (p < 0.01). There were fewer complications after vein harvesting in the EVH group (11.5%) than in the OVH group (44.4%) (p = 0.001). Multivariate analysis showed that diabetes mellitus was the only risk factor for post-surgical complications after OVH (odds ratio = 3.95%; 95% confidence interval 1.03-8.6). Lymphoscintigraphic data in the EVH group did not demonstrate considerable disturbances in lymph drainage after surgery. In the OVH group, the accumulation of radiopharmaceutical drugs in the lymphatic nodes reduced two-fold (p ≤ 0.001). Histological evaluation of vein samples did not show considerable damage to the vein wall in either group. Conclusions: Using electron microscopy of vein fragments, this study demonstrated that EVH reduces wound complications and provides good-quality conduits.