Bypass Technique Linked to Fewer Complications

Endoscopic vein graft harvest during bypass surgery found durable

(RxWiki News) A less invasive technique for harvesting leg veins for use in coronary artery bypass surgery has been found safe. This new procedure also appears to result in fewer wound complications such as infections.

The traditional harvesting technique involves long leg incisions to remove the veins, which are then grafted to improve blood flow in patients with clogged arteries.

The newer technique, called with endoscopic vein graft harvesting, allows surgeons to skip large incisions and instead use a device that leaves a mark smaller than a pencil cap eraser and removes the veins internally.

"Talk to a cardiologist about the pros and cons of surgery."

Judson B. Williams, MD, MHS, a lead investigator from Duke University Medical Center, noted that surgeons began using the newer technique in the mid-1990s as a means to relieve post-operative discomfort and reduce complications with leg incisions. By 2008, 70 percent of bypass patients received the endoscopic technique for harvesting veins for bypass surgery.

However, a large 2009 study suggested that patients who had veins harvested through the newer technique were more likely to die over a three-year period as compared to those who received open vein-graft harvesting, the most often used technique.

During the observational study, researchers reviewed data from 235,394 Medicare patients who received coronary artery bypass graft surgery between 2003 and 2008 at one of 934 surgical centers. The patients were followed for an average of three years.

Based on Medicare codes, investigators determined that 52 percent of patients received endoscopic vein-graft harvesting during bypass surgery.

Three-year mortality rates among both groups were similar with 13.2 percent of patients receiving the traditional harvesting procedure dying compared to 13.4 percent of endoscopic patients. Patients from both groups were also found to have similar risks for heart attack, requiring another artery-opening procedure or death.

Researchers also found that patients receiving the newer technique were slightly less likely to suffer complications from the leg wound. They determined that 3.6 percent of open graft patients suffered wound complications compared to 3 percent who received the endoscopic technique.

In an accompanying editorial, Lawrence J. Dacey, MD, MS, of the Dartmouth-Hitchcock Medical Center, said the study proves that the short-term benefits of endoscopic vein-graft harvesting are not associated with increased long-term risk.

"Physicians tend to do what is best for their patients. Patient satisfaction is markedly better with endoscopic vein-graft harvesting,” said Dr. Dacey. “Patients who have had both an endoscopic and open vein-graft harvest marvel at the difference in reduced pain and time of healing with endoscopic vein-graft harvesting.”.

The study was recently published in the Journal of the American Medical Association.

Review Date: 
July 31, 2012