Tamura Kiyoshi, Maruyama Toshiyuki, Sakurai Shogo
Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama 340-8560 Japan.
Indian J Thorac Cardiovasc Surg. 2021 Jan;37(1):38-43. doi: 10.1007/s12055-020-01063-3. Epub 2020 Oct 7.
One of the concerns during endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG) is injury to the vein or its branches. The cutting edge of bipolar electrocautery scissors, used to divide the side branches of the saphenous vein, can cause vascular injury leading to reduced graft patency. We have developed a novel back-approach technique using a C-ring to divide the wide side branches of the saphenous vein during EVH. The aim of the study was to describe the technique and assess early outcomes of EVH using this technique. The back-approach technique is as follows: (a) insert the C-ring near the target branch, (b) push the C-ring over the proximal aspect of the target branch, (c) twist the C-ring forward to capture the target branch, and (d) cut the target branch by bipolar electrocautery.
We investigated 169 patients, including 35 women (mean age 70.1 ± 8.9 years), who underwent CABG at our hospital, using a novel EVH technique. The patients were categorized as those who underwent EVH (EVH group, = 44) or open vein harvesting (OVH) (OVH group, = 125). This method involves the creation of a small incision (2 cm), sufficient saphenous vein dissection near the skin incision, adequate dissection to separate the vein from the surrounding tissues, and the back-approach technique with C-ring to divide the side branch of the saphenous vein. The primary endpoint was the graft patency rate, and the secondary endpoints were leg wound complications and length of hospitalization.
No significant intergroup difference was observed in early patency of saphenous vein graft patency (OVH vs. EVH = 94.7 vs. 95.6%, = 0.763). The incidence of lower extremity wound lymphorrhea was significantly lesser (OVH: EVH = 16.0: 0.0%, = 0.005) and the length of hospitalization was also significantly shorter in the EVH group (OVH vs. EVH = 24.2 ± 9.8 vs. 19.0 ± 5.3 days, = 0.001).
EVH, using the back-approach technique, showed satisfactory short-term results; therefore, this technique performed with C-ring might be effective for vein harvesting during EVH.
在冠状动脉旁路移植术（CABG）中采用内镜下大隐静脉采集（EVH）时，一个令人担忧的问题是静脉或其分支受到损伤。用于切断大隐静脉侧支的双极电凝剪刀的刀刃可能会导致血管损伤，从而降低移植物的通畅率。我们开发了一种新颖的后入路技术，在EVH过程中使用C形环来切断大隐静脉的粗大侧支。本研究的目的是描述该技术，并评估使用该技术进行EVH的早期结果。后入路技术如下：（a）将C形环插入目标分支附近；（b）将C形环推至目标分支的近端；（c）向前扭转C形环以夹住目标分支；（d）用双极电凝切断目标分支。
我们调查了169例在我院接受CABG的患者，其中包括35名女性（平均年龄70.1±8.9岁），采用了一种新颖的EVH技术。这些患者被分为接受EVH的患者（EVH组，n = 44）和开放静脉采集（OVH）的患者（OVH组，n = 125）。该方法包括做一个小切口（2厘米），在皮肤切口附近充分游离大隐静脉，进行充分的分离以将静脉与周围组织分开，以及使用C形环的后入路技术来切断大隐静脉的侧支。主要终点是移植物通畅率，次要终点是腿部伤口并发症和住院时间。
在大隐静脉移植物通畅的早期情况方面，未观察到显著的组间差异（OVH组与EVH组分别为94.7%与95.6%，P = 0.763）。下肢伤口淋巴漏的发生率在EVH组显著更低（OVH组：EVH组 = 16.0%：0.0%，P = 0.005），并且EVH组的住院时间也显著更短（OVH组与EVH组分别为24.2±9.8天与19.0±5.3天，P = 0.001）。
采用后入路技术的EVH显示出令人满意的短期结果；因此，这种使用C形环的技术可能对EVH期间的静脉采集有效。
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