Video-assisted saphenous vein harvest: The evolution of a new technique

Purpose: Saphenous vein harvesting remains a significant source of morbidity that occurs in 1% to 24% of patients who require lower extremity bypass or coronary artery bypass grafting. In an attempt to reduce complications associated with this procedure, we have used a new, minimally invasive technique to remove the greater saphenous vein. Methods: The video- assisted technique uses currently available video-endoscopic equipment with mechanical retraction to dissect the saphenous vein with two to three limited incisions. After initial vein exposure is accomplished through limited incisions, mechanical retraction is maintained with an endoplastic retractor or an endoscopic saphenous vein retractor. The dissection is visualized on the video monitor to isolate and control side branches, the vein is removed, and arterial bypass grafting is then accomplished as a reverse vein graft. Results: Between Sep. 1994 and July 1996, 65 patients underwent 68 arterial bypass operations in which the greater saphenous vein was harvested with video-assisted techniques. Indications for bypass grafting included 31 patients with ischemic ulceration, 23 with rest pain, 11 with claudication, and three with popliteal aneurysms. Of the 68 bypass procedures performed, 52 were to below-knee vessels, 22 of which included tibial or peroneal anastomoses. Sixty-four patients (98.5%) had no significant complications related to this video-assisted technique. For all patients, the average time required to remove a 45 cm vein segment was 60 minutes. The average time using the more recently developed endoscopic saphenous vein retractor was 46 minutes. The median postoperative length of stay was 6 days. One patient had bleeding into the leg related to the video-assisted technique. Three patients (4.4%) required rehospitalization for wound care related to arterial access sites. Patency has been confirmed in 84% of grafts followed-up for a range of 1 to 24 months. Conclusions: In this report representing a series of unselected patients, video-assisted saphenous vein harvesting was technically feasible and had no immediate contraindications. The greater saphenous vein can be removed with minimally invasive techniques, leading to an acceptable morbidity rate, and is a satisfactory conduit for arterial bypass procedures. A prospective clinical trial may be justified to further evaluate the use of this technique in decreasing postoperative morbidity rates, shortening hospitalization, and improving patient care.