Patient Satisfaction and Clinical Complications after Endoscopic or Surgical Saphenous Vein Harvesting

 

 All articles of this category

Objectives: Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been developed to reduce leg wound problems. This study was undertaken to evaluate postoperative complications and patient's subjective satisfaction comparing EVH and surgical vein harvesting (SVH).

Methods: From January to May 2017, patients undergoing elective cardiosurgery (CABG, CABG + Valve) underwent saphenous vein graft harvesting either by EVH (n = 40) or SVH (n = 51). Both groups of patients were preoperatively similar regarding gender, age, BMI, diabetes mellitus, peripheral arterial occlusive disease, and EuroSCORE II. Significant differences were present regarding chronic use of steroid drugs and smoking addiction. Clinical follow-up was scheduled for day 7 and >45 days after surgery. Primary endpoints were divided into two subgroups. The first one included postoperative extent of subjective pain and satisfaction with the cosmetic results described by the patients themselves while the second subgroup included objective postoperative complications including wound healing problems, cellulitis, purulent infections, hematoma, neuropathy, and lymphatic drainage disturbance. Secondary endpoint was length of hospital stay.

Results: No intraoperative problems occurred in both groups. At 7 days follow-up EVH patients were more satisfied with the cosmetic results than those of the SVH group (p < 0.001) and exhibited significantly fewer lymphatic wound healing disturbance (p = 0.023). With regard to cellulitis, purulent infections, hematoma, neuropathy, and lymphatic drainage disturbance no significant difference was found between the both groups but EVH patients expressed a nonsignificant tendency to lower subjective pain compared with the SVH patients (p = 0.084). During further follow-up at >45 days patients with EVH were still more satisfied with the cosmetic results (p = 0.003) whereas all objective wound parameters did not show significant differences between both groups. Mean length of hospital stay of EVH patients was one day less compared with SVH patients without reaching significance (p = 0.39).

Conclusion: Our findings demonstrate the non-inferiority of EVH compared with SVH. SVH patients themselves, however, were more satisfied with the cosmetic results than conventionally treated patients. It remains a matter of debate and is subject to another study as to whether EVH or SVH is superior in terms of long-term patency of the graft itself.