•No-Touch Endoscopic Vein Harvesting (NT-EVH) was performed using our previously published technique (details are described in "How to Perform NT-EVH").

•Patient data were collected retrospectively.

•

1.1-year graft patency

2.Wound infection, defined as any complication requiring surgical intervention or antibiotic therapy

•Categorical variables are presented as counts (percentage), and continuous variables are shown as mean ± standard deviation or median (interquartile range), as appropriate.

•Comparisons between groups were performed using Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank-sum test for continuous variables.

•Kaplan–Meier analysis was used to assess graft patency over time.

•A p-value < 0.05 was considered statistically significant.

•All analyses were conducted using EZR, a graphical interface for R.

③Results

A total of 116 grafts were harvested from 108 patients using NT-EVH between August 2018 and November 2024.

 Postoperative CT angiography was conducted in 99 patients (92%), assessing 107 grafts. The early patency rate of NT-SVGs was 98% (105/107)[Table 3].

A CT angiography was performed one year after surgery in 48 cases (51 anastomoses) out of 67 cases.

 

Using the Kaplan-Meier method, the one-year patency rate was calculated at 96.9% (95% CI: 86.7-99.3%).

 

How to perform NT-EVH

 Vasoview Hemopro 2® is used for NT-EVH

 

1.  Anterior and posterior surface of SVG are harvested preserving perivascular   connective tissue using Vasoview dissector [Fig.1a].

2.  Lateral surface are dissected with Vasoview harvester with preserving perivascular   adipose tissue [Fig. 1b].

3.  Marking on anterior surface of SVGs are performed for the prevention of twisting of   SVGs [Fig. 1c].

4.  SVGs are expanded with arterial pressure for the preparation before anastomosis   [Fig.1d].

④Discussion

 In the current study, NT-EVH demonstrated excellent one-year graft patency. Our previous research showed that saphenous veins harvested via NT-EVH preserved key histological features—such as intact perivascular adipose tissue, intimal folding, and patent vasa vasorum—similar to those of open NT-SVG [3, Fig. 3].

To maintain these characteristics, it is essential to harvest the vein as a "living graft." Additionally, preventing twisting and thrombus formation is critical for avoiding early graft failure. To address this, we routinely mark the vein endoscopically and delay transection until after full heparinization.

 

We did observe three cases of leg wound complications. In each of these, the deep fascia was injured during harvesting. This highlights the importance of preserving the deep fascia to minimize the risk of bleeding and infection