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Review
. 2021 Mar;13(3):1899-1908.
doi: 10.21037/jtd-20-1819.

Endoscopic vein harvesting

Enoch Akowuah  1 , Daniel Burns  2 , Joseph Zacharias  3 , Bilal H Kirmani  2
Affiliations
Review

Endoscopic vein harvesting

Enoch Akowuah et al. J Thorac Dis. 2021 Mar.

Abstract

Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009-2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.

Keywords: Coronary artery bypass; conduit; endoscopic; minimally invasive; saphenous vein.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1819). The series “Minimally Invasive Cardiac Surgery” was commissioned by the editorial office without any funding or sponsorship. JZ reports proctoring and speaking fees from Edwards Lifesciences, Cryolife, and Abbott, and funded a clinical fellow post for 12 months from LSI solutions. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Images from pre-operative ultrasound scanning of long saphenous vein. (A) The vein in short axis; (B) a side branch appearing in long axis; (C) a vein in short axis measuring 0.96 cm with calipers—this could be a varicosity, a patulous vein or a confluence of vessels.
Figure 2
Figure 2
Endoscopic vein harvesting equipment from various manufacturers. (A) VasoView Hemopro 2 (Getinge AB, Sweden) (Image© Getinge, used with permission); (B) Vascuclear (LivaNova, London, UK) (Image© LivaNova, used with permission); (C) VirtuoSaph® Plus (Terumo, Tokyo, Japan) (Image© Terumo Cardiovascular, used with permission).
Figure 3
Figure 3
A view through an endoscope at the CO2-insufflated dissection tunnel for the long saphenous vein (white arrow). A side branch can be seen extending superficially (black arrow). (Image© Getinge).
Figure 4
Figure 4
The long saphenous vein is retracted using the device C-arm distally in the tunnel (white arrow), while a side branch is cauterised and transected (black arrow). (Image© Getinge).
See this image and copyright information in PMC

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