Methods
The study was approved by our department, and all patients signed a
written informed consent. The patients provided written informed consent
for publication of the images. A prospective, parallel group trial was
undertaken to compare an endoscopically vein harvested technique (EVH)
with open vein harvesting technique (OVH)) in (100) patients admitted
for elective CABG divided into EVH group (50) and OVH group (50) between
January 2018 to October 2020. Patients were placed in either group
according to surgeon′s preference or availability of instrument for EVH.
Informed consent was taken in every case. We excluded cases which
converted to OVH, and when combined technique is used (both EVH and
OVH).
SVG was harvested from the thigh and, if more length needed, the leg
using the same entry point incision over the medial epicondyle in (15)
cases. GSV was exposed by means of a 2 cm transverse incision along the
medial surface of the knee. The vein was dissected free and surrounded
by a vessel loop. Subcutaneous tunnels were created distally and
proximally. The endoscopic dissecting device VirtuoSaphPlus was then placed in the proximal space (towards
groin). A tunnel was created by blunt dissection along the length of the
saphenous vein in the thigh. After 3-5 cm of blunt dissection,
insufflation was performed by using Carbon dioxide to a pressure of 13
mm of Hg and flow 4 L/min. without an insufflation port to avoid
incidence of embolism. Some cases did not given heparin before
harvesting and CO2 insufflation to avoid preoperative heparin and excess
bleeding during mammary harvesting. Pull the scope and dissection tip
back to the incision site and gently slid tip posterior to the vein. The
vein was circumferentially dissected and its tributaries were
identified. Further dissection of adherent tissue was performed by using
a C-ring dissector and bipolar loop scissors (dissector cautery device).
Once all tributaries were divided, a 2.5 cm incision was made at the
groin and the dissected vein isolated. The proximal portion of the vein
was divided. The same procedure was repeated for the distal vein
(towards ankle) for more length. Several disposable systems are
available, most frequently used is VirtuoSaph by Terumo. Harvested vein
was gently distended with heparinized saline and the branches secured
with small clips or repaired by 7-0 Prolene sutures if needed. The wound
was closed at the end of the procedure after protaminisation was
complete, and drains (Radivac) were used only in (25) cases. Time spent
was approximately (45-60min.) in the first, then reduced to (30-35min.).
The leg was then wrapped in an elastic bandage for 48 hours. Pain
assessment and wound examination was performed daily, 2 weeks, 4 weeks
after discharge.