Endoscopic Vein Harvest: A Debate Over Outcomes
Harvesting veins for bypass using minimally invasive endoscopic technique vs. open surgery has become a routine choice for vascular surgeons, but controversy remains regarding the efficacy of the procedure. Dr. Peter Gloviczki, Director of the Gonda Vascular Center at the Mayo Clinic (Rochester, MN), advocates for the endoscopic technique, citing rapidly improving and money-saving technologies as well as studies showing improved wound healing and vein function. However, Dr. Thomas E. Brothers, Program Director in Surgery at the Medical University of South Carolina (Charleston), has recently completed a ten-year retrospective study finding significantly better outcomes for open surgery. Today at the 33rd annual VEITHsymposium™, these distinguished vascular surgeons debated whether the drawbacks to endoscopic vein harvest were outweighed by the advantages.
New York (PRWEB) November 17, 2006
Harvesting veins for bypass using minimally invasive endoscopic technique vs. open surgery has become a routine choice for vascular surgeons, but controversy remains regarding the efficacy of the procedure. Dr. Peter Gloviczki, Director of the Gonda Vascular Center at the Mayo Clinic (Rochester, MN), advocates for the endoscopic technique, citing rapidly improving and money-saving technologies as well as studies showing improved wound healing and vein function. However, Dr. Thomas E. Brothers, Program Director in Surgery at the Medical University of South Carolina (Charleston), has recently completed a ten-year retrospective study finding significantly better outcomes for open surgery. Today at the 33rd annual VEITHsymposium™, these distinguished vascular surgeons debated whether the drawbacks to endoscopic vein harvest were outweighed by the advantages.
Dr. Gloviczki began by citing the significant advantages endoscopic techniques offer to patients. As the technology has improved, so have surgeons' skills, resulting shorter surgery times and better outcomes. In addition, studies have found that endoscopic techniques significantly reduce both the rate and severity of local wound complications, resulting in reduced postoperative hospitalization stays and readmission rates. This translates to a significant overall cost savings to patients (up to $180,000 in certain studies).
However, researchers are still investigating whether the endoscopic procedure itself may cause long-term vein trauma that limits patency (clear blood flow). Dr. Gloviczki noted that several studies have investigated the effects of endoscopic harvest on vein function but failed to show a deleterious effect. Likewise, early and late patency rates of grafts harvested endoscopically equal those procured by open techniques.
Dr. Gloviczki noted that patients appreciate the decreased morbidity of vein harvest and are pleased to spend less days in the hospital. "A multicenter prospective randomized study with sufficient number of patients is still needed, Dr. Gloviczki said, to confirm the obvious advantage of endoscopic harvest. Considering that those who do endoscopic harvest, do not want to go back to the old technique, as such study in the United States may no longer be possible. Quality of life studies and comparisons with historic controls may be the only way now to study this issue.
Dr. Brothers' own study findings have led him to a sharply different conclusion. Over a ten-year period, Dr. Brothers gradually abandoned his standard technique of harvesting veins through a single long incision in favor of multiple short incisions with or without the aid of endoscopy. An analysis of the postoperative results at five years showed that primary patency was significantly worse after multiple incisions (33%) or multiple incisions with endoscopy (44%) as compared to single incision vein harvest (59%), as was secondary patency. In addition, Dr. Brothers' study did not support the advantages cited in earlier studies, finding no evidence that a learning curve was present, no differences in the overall rate of reintervention for compromised grafts, and no differences in the incidence of wound complications between the two procedures.
The findings from our study are at odds from those in which endoscopically-harvested veins are used for coronary revascularization instead of for bypass in the leg, and it should not be interpreted to imply that the minimally invasive concept of saphenous vein harvest is flawed. Rather, limitations in the vein harvest technology available at the time of the study as well as perhaps my own limitations in the use of that technology may well have contributed. However, the study does underscore the importance of continued aftermarket evaluation of all technologies by the individual surgeons utilizing it to confirm or refute its beneficial application in everyday practice.
About VEITHsymposium™: Now entering its fourth decade, VEITHsymposium™ provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features 300 rapid-fire presentations from the world's most renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.
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