Less Invasive Surgery Safe for Harvesting Bypass Veins: Study

No major difference in outcomes of coronary artery bypass graft with minimal or large leg incisions

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_127775.html

(*this news item will not be available after 10/29/2012)

By Robert Preidt

Tuesday, July 31, 2012

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TUESDAY, July 31 (HealthDay News) -- The use of minimally invasive endoscopy to harvest leg veins used in coronary artery bypass graft surgery is as safe as using ankle-to-groin incisions, a new study has found.
The findings contradict previous research that linked the endoscopic method to higher rates of vein bypass graft failure, heart attack and death.
For the study, researchers from Duke University Medical Center looked at nearly 236,000 Medicare patients who underwent coronary artery bypass graft surgery between 2003 and 2008. The endoscopic method of harvesting leg veins was used in 52 percent of the patients.
After three years of follow-up, there were no major differences between the endoscopic vein harvesting group and the open vein harvesting group in rates of death (13.2 percent versus 13.4 percent, respectively) or heart attack and revascularization (19.5 percent versus 19.7 percent, respectively).
Patients who underwent the minimally invasive procedure had lower rates of wound complication (3 percent for endoscopic vein harvesting and 3.6 percent for open vein harvesting) and infections, according to the study in the Aug. 1 issue of the Journal of the American Medical Association.
"Our study affirms the efficacy of endoscopic vein harvesting," senior author Dr. Peter Smith, chief of cardiovascular and thoracic surgery, said in a Duke news release. "It allays the concerns of patients who have undergone endoscopic vein harvesting during coronary artery bypass, as well as the concerns of surgeons who prefer endoscopic vein harvesting for their patients."
He noted that the study "was done in a very large population, and was conducted in a diverse group of large and small community programs, as well as university and non-university affiliated centers."
"It's unlikely another result would occur if more patients were studied," he added.
Dr. Sunil Abrol, chairman of surgery and director of thoracic surgery at Brookdale University Hospital and Medical Center in New York City, commented on the findings.
Abrol said endoscopic vein harvesting has been controversial and was thought to lead to narrowed grafts, which "translates to increased mortality, more [heart attacks] and a higher risk of re-intervention."
He said, however, that "patients find endoscopic vein harvest more comfortable, they have less pain and swelling in the legs, can [walk] sooner, and there is a significant reduction in wound-related complications and readmission rates."
The new study begins to put to rest some doubts raised about the procedure in a previous study, Abrol said, adding that endoscopic vein harvesting warranted further research.

SOURCES: Sunil Abrol, M.D., chairman of surgery and director of thoracic surgery, Brookdale University Hospital and Medical Center, New York City; Duke Medicine, news release, July 31, 2012

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