Technical Tips for A No-touch Endoscopic Saphenous Vein Harvesting 

The Saphenous Vein Graft (SVG) remains a vital component in coronary artery bypass grafting. Its advantages include availability, length, ease of harvesting, and handling. However, it's crucial to address the significant drawbacks such as reduced long-term patency and potential leg wound complications associated with traditional harvesting methods.

In the ESC guidelines, Endoscopic Vein Harvesting (EVH) is recommended to reduce wound complications, while the No-touch harvesting technique is advocated for enhancing long-term patency.

 

Our NT-EVH technique is meticulously designed to preserve the histological features of the saphenous vein, ensuring the integrity of the intimal layer and maintaining the vasa vasorum. By avoiding direct contact and minimizing trauma during extraction, we uphold the structural and functional viability of the vein. We have demonstrated that no-touch EVH effectively preserves these critical histological features, including intimal folding and patent vasa vasorum.

 

A 131 anastomosis of 77 cases was performed using the NT-EVH technique. The average patient age was 68 years, and 68% had diabetes. We included 11 emergency cases.In our procedures, 14 were concomitant surgeries, 75% were off-pump, and 36% used minimally invasive techniques. The average operation time was 322 minutes, and harvesting took about 61 minutes. There was only one incident of graft injury, which required converting to open harvesting.

 

The early patency rate was 98%, and the CT images showed good, smooth saphenous vein grafts. We encountered just one wound complication, which we will discuss further.