Objective: To compare the efficacies of endoscopic harvesting saphenous vein as sequential graft by pedicled and scheltoned technique.
Methods: From June 2013 to December 2013, a total of 93 patients undergoing coronary artery bypass with endoscopic vein harvesting in shank were recruited. Saphenous veins were harvested by pedicled method in group A (n =46) and scheltoned method in group B (n =47). Harvesting method was decided by a random number for each patient. Saphenous veins were used as sequential grafts during off-pump coronary artery bypass. Inter-group comparisons were made in time for harvesting, time for repairing, venous injuries and perioperative effect of saphenous vein. The postoperative follow-up period was 30 days. Early failure of saphenous vein graft was evaluated with coronary computed tomography (CT) angiography.
Results: All saphenous veins in shank were harvested successfully. No significant difference existed in vein length. In groups A and B, average time for harvesting was (21. 7 ± 5. 6) and (27. 4 ± 6. 4) min (P < 0. 05) and time for repairing (7. 2 ± 2. 7) and (10. 6± 4. 4) min respectively (P <0. 05). No severe injury resulted in non-using of saphenous in both groups. The repair rates of saphenous vein were 10. 9% and 38. 3% respectively (P < 0. 05). For each repaired saphenous vein, the average number of locations was (1. 6 ± 0. 5) and (3. 1 ± 1. 0) sites respectively (P < 0. 05). All patients were discharged uneventfully. There was no perioperative onset of myocardial infarction or malignant arrhythmia. For groups A and B, 89. 1% and 93. 6% were followed up for 1 month post-operation. No angina, myocardial infarction or heart failure occurred. For groups A and B, 32 and 37 cases were re-examined on CT coronary angiography and all saphenous vein grafts maintained patency.
Conclusions: Pedicled method is more safe and reliable for endoscopic saphenous vein harvesting. It can ensure the quality of sequential graft, shorten harvesting time and reduce the risks of vein injury.