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“Endoscopic Saphenous Vein Harvest Decreases Leg Wound Complication in Coronary Artery Bypass Grafting Patients”

Dr. Yang and colleagues describe their method of endoscopic greater saphenous vein harvest for use in coronary bypass surgery. They report the vein can be harvested in a reasonable amount of time and that it appears to be in satisfactory condition. The perceived benefits of this endoscopic harvest method include a better cosmetic result and fewer wound complications compared to traditional vein harvest. The objective assessment of what constitutes a harvest site complication is not easy. If one chooses incisional pain, ecchymoses, and peripheral edema as complications virtually every patient would have a complication. On the other hand, very few patients have life or limb threatening complications regardless of vein harvest technique. It is the middle ground, those poorly healing, superficially infected incisions which are immensely aggravating to both patient and physician, but which ultimately heal without sequelae, that may be most favorably affected by endoscopic harvest technique. Is endoscopic vein harvest a method we should all adopt given that most of the potential benefits are short term? Or is this just another marketing ploy we can use to attract patients? If one does opt to proceed with endoscopic harvest, what is the cost and are there potential downsides? The most serious potential problem with endoscopic vein harvest would be a decrement in long term patency. There is nothing inherent in endoscopic vein harvest which would affect patency provided the same care is taken as in traditional techniques to avoid vein trauma and intimal damage. That, however, is easier said than done as endoscopic harvest is not easy to learn and requires time and experience to become adept a t its performance. A number of surgeons in my group have used endoscopic vein harvest allowing me some observations. The biggest problem in adopting this technique is its learning curve. It is extremely frustrating for the surgeon and assistant alike to make the vein harvest a rate limiting, arduous step in a routine coronary operation. It is also apparent that endoscopic vein harvest does not eliminate post harvest problems. Ecchymoses are usually present and deep fluid collections are not uncommon. These may become secondarily infected requiring incision and drainage. Neuralgias do occur and peripheral edema is frequent. If one is fortunate enough to have an assistant who has mastered endoscopic vein harvest technique, it can be done expeditiously and routine, particularly if only the thigh vein is required. The benefits of endoscopic vein harvest are in large part subjective. In lower risk, thinner patients traditional and endoscopic techniques achieve similar results. The major benefit of endoscopic vein harvest is in the high risk, obese, older, diabetic patient. Unlike Dr. Yang's patient profile, this type of patient constitutes a large portion of American practices. As such, endoscopic vein harvest capability is an attractive addition to a coronary surgery practice armamentarium.