Study allays concerns about endoscopic vein harvesting during heart surgery

July 31, 2012

Using an endoscope to guide the removal of leg veins used in heart surgery is as safe as using large, ankle-to-groin incisions, according to a study by Duke University Medical Center researchers.

The data, published today in JAMA, shows the two procedures have similar after three years. The endoscopic method has lower rates of infection and wound complications.

Today's study refutes previous findings linking the endoscopic method to higher rates of vein bypass , heart attack and death.

"Our study affirms the efficacy of endoscopic vein harvesting," says Peter K. Smith, M.D., chief of cardiovascular and thoracic surgery at Duke and the paper's senior author. "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."

Since the mid-1990s, surgeons have used endoscopes and tiny incisions at the ankle, knee and groin to remove leg veins during (CABG). The minimally caught on quickly because it resulted in shorter hospital stays, less perioperative discomfort, fewer incision-site complications and less scarring than open vein harvesting, which requires an incision that runs the length of the leg.

" is among the most commonly performed procedures worldwide," says Judson Williams, M.D., M.H.S., the study's first author and a Cardiothoracic Surgical Trials Network fellow at Duke. "This procedure is designed not only to prolong a patient's life, but to also improve their quality of life. Because of the importance of this operation, ensuring it can be done with the best is critically important."

Three years ago, an observational study of 3,000 patients called into question the safety of endoscopic vein harvesting. The U.S. then commissioned the Duke researchers to study the long-term outcomes of endoscopic (EVH) versus open vein harvesting (OVH).

This FDA-sponsored observational study followed 235,394 Medicare patients undergoing CABG from 2003-2008 in 934 surgical centers participating in the Society of Thoracic Surgeons national database. About half (52%) were endoscopic cases. Baseline patient characteristics were balanced across both groups including age, body mass index, prevalence of vascular disease, and other risk factors such as smoking, diabetes and urgent care status.

After three years of follow-up, there were no significant differences in mortality between the two groups (13.2% for EVH vs 13.4% for OVH). There were also no statistical differences in heart attacks or revascularization (19.5% for EVH vs 19.7% for OVH). There was a significant difference in the 30-day rate for wound complication favoring endoscopic harvesting: (3.0% for EVH vs. 3.6% for OVH).

While several studies have questioned its safety, Smith says, "our 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."

In addition to providing insight into this critically important clinical question, the study represented an important collaboration, said Williams, a surgical resident at Duke. "This is an exciting example of an opportunity to achieve post-market medical device surveillance through collaboration between the FDA, the Society of Thoracic Surgeons, the Duke Clinical Research Institute and the NIH-supported Cardiothoracic Surgery Clinical Trials Network. It demonstrates a new and powerful method to answer important clinical questions in the future."

Explore further: Study shows survival advantage for bypass surgery compared with non-surgical procedure

More information:
JAMA. 2012;308[5]:475-484.
JAMA. 2012;308[5]:475-484.

Related Stories

Study shows survival advantage for bypass surgery compared with non-surgical procedure

March 27, 2012
A new comparative effectiveness study found older adults with stable coronary heart disease (CHD) who underwent bypass surgery had better long-term survival rates than those who underwent a non-surgical procedure to improve ...

Recommended for you

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.