No-Touch Versus Endo Vein Harvest: Early Patency on Symptom-Directed Catheterization and Harvest Site Complications

Mannion, John D. MD*; Marelli, Daniel MD*; Brandt, Todd PA-C*; Stallings, Megan PA-C*; Cirks, Jeffery PA-C*; Dreifaldt, Mats MD; Souza, Domingos MD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000084
Original Articles
Abstract

Objective: “No-touch” (NT) saphenous vein harvesting preserves the adventitial vasa vasorum, prevents medial ischemia, and is associated with an improved short-term and long-term vein graft patency. It may also be associated with a higher rate of harvest site complications. Endovascular vein harvesting (endo-vein) has a low rate of harvest site complications but also a tendency toward a lower patency rate.

Methods: During a 2-year period (2011-2012), we compared the vein graft patency at symptom-directed cardiac catheterization as well as wound complication rates in 210 patients who received either NT (87 patients) or endo-vein (123 patients).

Results: The recatheterization rate for the two groups was similar: 9 (10.3%) of 87 of the NT patients versus 11 (9.0%) of 123 of the endo-vein patients. There was a significant difference in vein graft patency between the groups: 15 (94%) of 16 NT vein grafts were patent versus 6 (27%) of 22 of endo-veins (P < 0.02). The endo-vein graft patency during this 2-year period was similar to the total endo-vein patency (37%) during a 4-year period. A comparison between a more experienced and a less experienced harvester revealed no difference in patency rate. Harvest site complications were significantly higher with the NT harvest: 18% of the NT patients requiring vacuum-assisted wound closure or intravenous antibiotics versus 2% of the endo-vein patients (P < 0.0001). The application of platelet-rich plasma did not significantly lower wound complication rates (P = 0.27).

Conclusions: These results suggest that NT vein harvesting may be associated with improved graft patency, but methods should be developed to lower wound complication rates.

Author Information

From the *Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, Dover, DE USA; and †Department of Thoracic and Cardiovascular Surgery, Orebro University Hospital, Orebro, Sweden.

Accepted for publication December 31, 2013.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 12–15, 2013, Prague, Czech Republic.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to John D. Mannion, MD, Division of Cardiac Surgery, Department of Surgery, Bayhealth Medical Center, 540 S. Governors Ave, Dover, DE 19904 USA. E-mail: john_mannion@bayhealth.org.

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery