18. Endoscopic Versus Open Saphenous Vein Harvest: The Effect on Wound Complications, Incisional Pain, and Length of Hospital Stay.
Thomas Z. Hayward, Lloyd A. Hey, Peter K. Smith, James E. Lowe, Francis G. Duhaylongsod
Duke University Medical Center
Durham, N.C.
Background: Open sephenous vein harvest (OVH) is associated with wound complications, Incisional pain, and prolonged convalescence. Endoscopic vein harvest (EVH) has been promoted as a solution to these problems. This study objectively compared OVH to EVH with regards to wound complications, pain, and hospital stay.
Methods: One hundred patients were prospectively randomized to EVH or OVH (50 per arm). Primary outcomes were wound complications (ecchymosis, leg infection, cellulitis, and hematoma), pain (Medical Outcomes Study Pain Survey Score; normalized score with -1 = one standard deviation below average pain), and hospital stay. Secondary outcomes were cosmesis (0 = poor to 5 = excellent) and harvest time (includes preparatory time). Patients were assessed at hospital discharge, three- and six-weeks post discharge. Mean ± standard deviaton are reported; Students t-test and chi-sq analysis were applied where appropriate.
| EVH | OVH | p Value | |
| Vein length (cm) | 47.8 ± 15.7 | 40.5 ± 14.2 | 0.050 |
| Number of bypasses | 3.2 ± 0.9 | 3.1 ± 0.9 | 0.588 |
| Harvest time (min) | 70 ± 18 | 56 ± 25 | 0.002 |
| Pain | - | - | - |
| 3 weeks | 0.38 ± 1.16 | -0.06 ± 0.93 | 0.053 |
| 6 weeks | 0.51 ± 1.32 | 0.42 ± 1.28 | 0.736 |
| Wound Complications (%) | - | - | - |
| ecchymosis | 44.0 ± 5.0 | 28.0 ± 4.5 | 0.097 |
| leg infection | 10.0 ± 3.0 | 12.0 ± 3.2 | 0.752 |
| cellulitis | 8.0 ± 2.7 | 8.0 ± 2.7 | 1.000 |
| hematoma | 4.0 ± 2.0 | 2.0 ± 1.4 | 0.562 |
| Hospital stay (days | 5.6 ± 1.1 | 6.0 ± 2.9 | 0.714 |
| Cosmesis (score of four or five) | 4.5 ± 0.51 | 4.3 ± 0.5 | 0.031 |
Conclusions: Although EVH provides a superior cosmetic result, a lack of demonstrable clinical benefit regarding wound complications, incisional pain, or length of hospital stay, coupled with higher operating room costs, fail to support its widespread use at this time.