Less Invasive Surgery Safe for Harvesting Bypass Veins: Study

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.

More information

The U.S. National Heart, Lung, and Blood Institute has more about coronary artery bypass graft surgery.

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