Endoscopic versus Open Saphenous Vein Harvest in Patients Undergoing CABG, an Angiographically Measured Graft Patency Comparison

Background: Endoscopic vein harvest (EVH) was introduced in 1996 as an alternative to open vein harvest (OVH) for coronary artery bypass graft (CABG) surgeries utilizing the saphenous vein. EVH has been shown to decrease post operative pain, wound complications, and length of hospital stay. Although EVH has become the preferred method of saphenous vein harvest, the effect of EVH on graft patency has not been well studied. A study published in the New England Journal of Medicine in 2009 concluded that EVH was independently linked to increased morbidity and decreased graft patency. This surprising conclusion was not endorsed by the cardiothoracic community. Much debate about the effect of EVH on graft patency has ensued, however, surgical practice appears to have remained unchanged. The potential harm of EVH must be weighed against its proven benefits in the light of the large number of patients that undergo EVH annually as the predominant mode of saphenous vein harvest Methods: An exhaustive literature search was performed using OVID, Web of knowledge, EBMR, CINAHL, and clinicaltrials.gov with the following search terms: coronary artery bypass graft, endoscopy, saphenous vein, graft occlusion, and vascular patency. Three studies were identified; two randomized controlled trials and one retrospective cohort study. Several trials examining graft patency in comparing EVH to OVH that utilized clinical outcomes (such as myocardial infarction, revascularization, stroke or death) as surrogate endpoints were excluded. Results: Of the three included studies, two studies determined that there was no statistical significance in occlusion rates when comparing EVH to OVH grafts. One study, referenced above, did determine statistically significant higher occlusion rates in EVH grafts as compared to OVH grafts. Conclusion: Further research is needed to adequately explore the relationship between EVH and graft patency associated morbidity. Such research would need to address many confounding variables while including a large sample population with angiography patency measurements at predetermined time points. The limited state of current research has failed to demonstrate statistically significant harm that may otherwise persuade the Society for Thoracic Surgery to ignore the important proven benefits of EVH over OVH. At this juncture, EVH remains the predominant method of saphenous vein harvest for patients undergoing CABG surgery