"No-Touch" versus "Endo" Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications. Issue 4 (July 2014)

• Record Type: Journal Article
• Authors: Mannion, John D.; Marelli, Daniel; Brandt, Todd; Stallings, Megan; Cirks, Jeffery; Dreifaldt, Mats; Souza, Domingos
• Is Part Of: Innovations. Volume 9:Issue 4(2014)
• Page Start: 306
• Page End: 311
• Publication Date: 2014-07
• Subjects: No-touch saphenous vein harvesting -- Endoscopic vein harvesting -- Saphenous vein patency -- Wound complications; Cardiovascular system -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; Thoracic Surgical Procedures -- methods -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Thorax -- Chirurgie -- Méthodologie -- Périodiques; Vaisseaux sanguins -- Chirurgie -- Méthodologie -- Périodiques; Blood-vessels -- Surgery; Chest -- Surgery; Periodicals; 617.41
• DOI: 10.1097/imi.0000000000000084
• Languages: English
• ISSNs: 1556-9845

Abstract

Objective: "No-touch" (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate. Methods: During a 2-year period (2011–2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients). Results: The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins ( P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients ( P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates ( P = 0.27). Conclusions: These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.