Compare Endoscopic and Open Methods of Vein Harvesting for Coronary Artery Bypass Grafting
Condition: Autovenous Conduit for Coronary Artery Bypass Grafting
Study type: Interventional
Phase: Phase 4

Summary: 
      There is no shared vision relating to integrity and quality of the conduit after the impact
      on the vein wall during vein harvesting. In this connection, the investigators studied the
      initial state of the venous conduit, interoperation damages of the vein and postoperative
      wound complications while using two methods of GSV harvesting.
    

Detailed description: 
      The great saphenous vein (GSV) remains one of the most commonly used conduits due to its ease
      of harvest, availability and versatility [1] Traditional harvesting of GSV is open vein
      harvesting, which involves an extended leg incision. This technique is associated with a
      significant morbidity and wound complications occur in 2-24% of cases.

      Minimally invasive techniques endoscopic vein harvesting (EVH), have therefore been developed
      to reduce post-CABG leg wound complications. Last time the endoscopic vein harvesting is the
      method of choice in many centers as it allowed reduction of post-surgical complications as
      compared to the open method. Although long-term graft patency following EVH has been
      questioned cohort studies have reported that the technique is safe and effective.

      The possibility to use lymphoscintigraphy for evaluation of lower limb lymphatic system after
      vein harvesting for the coronary artery bypass surgeries was reported before. Nevertheless,
      the state of the lymphatic system after vein harvesting remains to be poorly studied.

      Currently, there is no shared vision relating to integrity and quality of the conduit after
      the impact on the vein wall during vein harvesting. In this connection, the investigators
      studied the initial state of the venous conduit, interoperation damages of the vein and
      postoperative wound complications while using two methods of GSV harvesting.
    

Intervention name(s): Open vein harvesting; Endoscopic vein harvesting
Intervention type(s): Procedure; Procedure
Intervention description(s): Open vein harvesting was performed as a continuous incision under vision control. The GSV was identified two fingers proximal to the medial malleolus according to the standard practice. The vein was harvested using Metzenbaum scissors, and a continuous incision was made along the route of the vein. Care was taken not to traumatize the nerve, vein or its branches. Vein branches were ligated with titanium clips. The wound was closed in layers with continuous 2-0 Polysorb sutures and 3-0 skin sutures.; Endoscopic vein harvesting was performed through minimal incisions with use of Vasoview 6 system (Maquet Medical Systems, Wayne, NJ, USA.) The vein was identified through a 3 cm incision below the knee. The incision site was sealed using a balloon port to create a tunnel inside the leg. A second unit with cautery was inserted via the port to cut and seal the tributary branches. A 1 cm skin incision was made near the groin to ligate the distal end of the GSV and remove the vein, which was checked for leakage. The wound was closed with 3-0 skin sutures
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment