Video-Assisted Vein Harvest: A Single Institution's Experience of 103 Peripheral Bypass Cases

Abstract

Traditional harvesting of the greater saphenous vein (GSV) has meant a long, continuous incision with the potential for increased morbidity, pain, and hospital stay. The authors have used a minimally invasive video-assisted technique in an attempt to reduce these complications. In this report, they retrospectively analyze a series of 103 cases of videoassisted saphenous vein harvests for vascular bypass procedures. All patients from September 1994 to May 1997 who underwent video-assisted saphenous vein harvest were reviewed for vein harvest time, hospital length of stay, surgical complications, graft patency, and clinical outcome. Operative technique used limited incisions, video-assisted dissection, and two different subcutaneous retractors-endoplastic (Type I) (Snowden Pencer, Tucker, GA) and endosaphenous (Type II) (Ethicon Endosurgery, Cincinnati, OH). Ninety-six patients underwent 103 operations for lower and upper extremity vascular disease. For all patients, the average time of vein removal was 0.74 cm vein/minute operative time, for procedures with the Type I retractor 0.63 cm vein/minute, for procedures with the Type II retractor 1.07 cm vein/minute (p≤0.0001). Postoperative length of stay (LOS) averaged 7.7 days (median 5 days) for all patients and was longer between patients with rest pain (6.4 days) and tissue loss (10.1 days) vs claudicants (4.4 days) (p<0.05), between patients with tibioperoneal anastomoses (10.0 days) vs patients with popliteal anastomoses (6.0 days) (p<0.05), and between Type I patients (8.3 days) and Type II patients (6.9 days) (p=0.03). Nine wound complications occurred (8.7%), two of which (1.9%) were directly related to the video-assisted technique. Cumulative graft patency was 84% ±9% after 18 months. According to the International Society for Cardiovascular Surgery reporting standards for lower extremity occlusive disease, patient outcome averaged +2.03 for all patients, and was improved between patients with claudication (+2.82) vs patients with rest pain (+1.50) (p<0.05) and between Type II patients (+2.36) vs Type I patients (+1.64) (p=0.01). Video-assisted saphenous vein harvest can be accomplished with low morbidity and provides a satisfactory conduit. The patients had a short postoperative LOS, a satisfactory wound complication rate, and a good operative outcome. The Type II saphenous vein retractor decreased operative time, shortened hospital LOS, and improved outcome.