Tunnelling versus open harvest technique in obtaining venous conduits for coronary bypass surgery

Background: The tunnelling as opposed to the open harvest technique for har vesting long saphenous vein for coronary artery bypass procedures is a less frequently used technique as it requires more handling of the vein and thi s may induce trauma. This study aims to compare the degree of endothelial d enudation and donor site morbidity between the two different harvest techni ques. Methods: Saphenous vein segments in 78 patients (45 in tunnelling ver sus 33 in open harvest group) undergoing coronary artery bypass procedures were examined by light microscopy and graded according to the extent of end othelial denudation varying from grade 1 (most preserved) to grade 6 (>90% endothelial denudation). Clinical parameters relating to donor site morbidi ty including leg wound pain and infection were also assessed. Results: Ther e was no statistical difference in the age, sex, macroscopic vein quality, length and time taken to harvest the veins between the two groups. The tunn elling technique always used thigh saphenous vein whereas nearly a third of veins harvested by the open harvest technique were lower leg veins (P = 0. 001). The tunnelling technique resulted in an endothelial score of 2.5 comp ared with 3.3 for the open harvest technique (P < 0.001). In addition, saph enous vein tunnelling resulted in significantly less leg wound pain (1.2 vs . 1.8, P = 0.001), no leg wound infection (compared with 12.2% in open harv est group, P = 0.02) and produced cosmetically more acceptable scars. Furth ermore, length of hospital stay was significantly prolonged to 19.3 days in those with leg wound infection compared to 8.7 days in those without leg w ound infection (P < 0.001). Conclusions: These results show that saphenous vein tunnelling is an attractive alternative to the open harvest technique in obtaining venous conduits for coronary artery bypass procedures. (C) 199 8 Elsevier Science B.V. All rights reserved.