Comprehensive Angiographic Evaluation of Graft Quality After Endoscopic Vein Harvesting in Coronary Artery Bypass Grafting
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Abstract
Background The saphenous vein graft (SVG) remains a mainstay conduit for coronary artery bypass grafting (CABG) due to its accessibility and length. Although the no-touch technique may improve long-term patency, wound complications are a continuing concern. Since 2011, our institution has adopted endoscopic vein harvesting (EVH) as the standard approach. This study provides angiographic insights into graft quality and patency after EVH compared with open vein harvesting (OVH), with additional assessment of mid-term clinical outcomes. Methods Among 471 patients who underwent CABG between 2005 and 2017, 307 were included in this study. Patients were divided into the EVH group (Group A, n = 134) and the OVH group (Group B, n = 173). Postoperative coronary angiography was used to evaluate SVG graft patency, anastomotic integrity, and graft body stenosis. Clinical outcomes including major adverse cardiac and cerebrovascular events (MACCE) and wound complications were also compared. Results Angiographic assessment demonstrated comparable SVG patency between the EVH and OVH groups (93% vs. 94%), with similar rates of anastomotic stenosis (2.2% vs. 2.3%) and severe graft stenosis (≥90%; 1.5% vs. 1.2%). No significant differences were observed in 30-day mortality (1.5% vs. 3.5%), in-hospital mortality (1.5% vs. 2.1%), or postoperative stroke. Wound-related complications were rare, including wound dehiscence (1.5% vs. 2.3%) and infection (0.7% vs. 1.2%). MACCE-free survival rates at 1, 3, and 5 years were 97%, 94%, and 91% in the EVH group versus 92%, 86%, and 76% in the OVH group, respectively (P = 0.070), showing a favorable trend in the EVH group. Conclusion Detailed angiographic evaluation revealed that EVH did not compromise graft quality or patency compared with conventional OVH. The incidence of wound complications was very low, and mid-term clinical outcomes were favorable. These findings suggest that EVH is a safe and reliable harvesting technique, providing high-quality grafts with excellent angiographic integrity. Individualized selection of harvesting strategy remains important for optimizing surgical outcomes.
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Abstract
Background The saphenous vein graft (SVG) remains a mainstay conduit for coronary artery bypass grafting (CABG) due to its accessibility and length. Although the no-touch technique may improve long-term patency, wound complications are a continuing concern. Since 2011, our institution has adopted endoscopic vein harvesting (EVH) as the standard approach. This study provides angiographic insights into graft quality and patency after EVH compared with open vein harvesting (OVH), with additional assessment of mid-term clinical outcomes.
Methods
Among 471 patients who underwent CABG between 2005 and 2017, 307 were included in this study. Patients were divided into the EVH group (Group A, n = 134) and the OVH group (Group B, n = 173). Postoperative coronary angiography was used to evaluate SVG graft patency, anastomotic integrity, and graft body stenosis. Clinical outcomes including major adverse cardiac and cerebrovascular events (MACCE) and wound complications were also compared.
Results
Angiographic assessment demonstrated comparable SVG patency between the EVH and OVH groups (93% vs. 94%), with similar rates of anastomotic stenosis (2.2% vs. 2.3%) and severe graft stenosis (≥90%; 1.5% vs. 1.2%). No significant differences were observed in 30-day mortality (1.5% vs. 3.5%), in-hospital mortality (1.5% vs. 2.1%), or postoperative stroke. Wound-related complications were rare, including wound dehiscence (1.5% vs. 2.3%) and infection (0.7% vs. 1.2%). MACCE-free survival rates at 1, 3, and 5 years were 97%, 94%, and 91% in the EVH group versus 92%, 86%, and 76% in the OVH group, respectively (P = 0.070), showing a favorable trend in the EVH group.
Conclusion
Detailed angiographic evaluation revealed that EVH did not compromise graft quality or patency compared with conventional OVH. The incidence of wound complications was very low, and mid-term clinical outcomes were favorable. These findings suggest that EVH is a safe and reliable harvesting technique, providing high-quality grafts with excellent angiographic integrity. Individualized selection of harvesting strategy remains important for optimizing surgical outcomes.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
The author(s) received no specific funding for this work.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study protocol was approved by the Institutional Review Board of Nihonkai General Hospital (Approval No. 007-4-12).
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Footnotes
Author conflict of interest: none
Data Availability Statement
Data is provided within the supplementary information file.
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