ENDOSCOPIC VERSUS TRADITIONAL SAPHENOUS-VEIN HARVESTING - A PROSPECTIVE, RANDOMIZED TRIAL

Background. Saphenous vein harvested with a traditional longitudinal t echnique often results in leg wound complications. An alternative endo scopic harvest technique may decrease these complications, Methods, On e hundred twelve patients scheduled for elective coronary artery bypas s grafting were prospectively randomized to have vein harvested using either an endoscopic (group A, n = 54) or traditional technique (group B, n = 58), Groups A and B, respectively, were similar with regard to length of vein harvested (41 +/- 8 cm versus 40 +/- 14 cm), bypasses done (4.1 +/- 1.1 versus 4.2 +/- 1.4), age, preoperative risk stratifi cation, and risks for wound complication (diabetes, sex, obesity, preo perative anemia, hypoalbuminemia, and peripheral vascular disease). Re sults, Leg wound complications were significantly (p less than or equa l to 0.02) reduced in group A (4% [2 of 51] versus 19% [11 of 58]). Un ivariate analysis identified traditional incision (p less than or equa l to 0.02) and diabetes (p less than or equal to 0.05) as wound compli cation risk factors. Multiple logistic regression analysis identified only the traditional harvest technique as a risk factor for leg wound complications with no significant interaction between harvest techniqu e and any preoperative risk factor (p less than or equal to 0.03). Har vest rate (0.9 +/- 0.4 cm/min versus 1.2 +/- 0.5 cm/min) was slower fo r group A (p less than or equal to 0.02) and conversion from endoscopi c to a traditional harvest occurred in 5.6% (3 of 54) of patients. Con clusions. In a prospective, randomized trial, saphenous vein harvested endoscopically was associated with fewer wound complications than the traditional longitudinal method. (Ann Thorac Surg 1995;66:26-32) (C) 1998 by The Society of Thoracic Surgeons.