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A Short-term Evaluation Of A Novel No-touch Technique For Harvesting Saphenous Veins With A Long-shafted Harmonic Scalpel
Hironobu Sakurai, Takeshi Someya, Hidehito Kuroki, Toshizumi Shirai.
Ome Municipal General Hospital, Tokyo, Japan.
BACKGROUND: The saphenous vein is widely used as a bypass conduit for coronary artery bypass grafting despite its inferior patency to other grafts. R. Souza illustrated a "no-touch technique" where saphenous veins were harvested with surrounding tissue. The patency was superior to the conventional technique. There were concerns regarding wound complications due to tissue defects. To solve this problem, we conducted a novel technique with separate skin incisions and harvested the vein and surrounding tissue using a long-shafted harmonic scalpel. The aim of this study was to demonstrate this method (the no-touch technique) and to report the early clinical outcomes.
METHODS: Beginning in October 2018, we harvested saphenous veins from the lower legs of male patients using a no-touch technique without comorbidity exclusion criteria.We mapped the course of the saphenous vein and assessed its’ quality by ultrasonography. We made several separate incisions of approximately 4 cm, leaving 5 cm intervening bridges of skin intact. With the harmonic scalpel, the vein was harvested after systemic heparinization along with an approximately 5-mm wide margin of adjacent adipose tissue on both sides and thin layers of adherent connective tissues antero-posteriorly. The procured vein was connected to a 4-Fr sheath inserted into the femoral artery and dilated spontaneously by arterial pressure. A 10-Fr silicone drain was inserted into the harvesting site subcutaneously prior to closing.Between April 2016 and September 2020, 63 male patients underwent isolated coronary artery bypass grafting and graft evaluation with coronary angiography before discharge at our institution (Table). RESULTS: There was no difference in the demographic data. Despite no significant patency superiority to the conventional technique, there was no occlusion of veins harvested with the no-touch technique. There was no significant difference in the frequency of wound complications.
CONCLUSIONS: The no-touch technique might improve the patency of saphenous veins. However, a large-scale and long-term study is required. Harvesting veins with separate skin incisions and using the long-shafted harmonic scalpel may reduce the frequency of leg wound complications. The no-touch technique may be feasible for harvesting saphenous veins, including veins from patients at high risk for wound complications.
LEGEND: Demographic data and Clinical outcomes
| Conventional | No-touch | p | |
| Number of patients | 34 | 29 | |
| Age (mean, years old) | 67.3 ± 10.6 | 68.6 ± 9.5 | 0.72 |
| Insulin-dependent diabetes mellitus | 9 (26.5%) | 6 (20.7%) | 0.77 |
| Hemodialysis | 1 (2.9%) | 4 (13.8%) | 0.17 |
| Peripheral arterial disease | 2 (5.9%) | 2 (6.9%) | 1.0 |
| Patency of saphenous veins | 95.2% (40/42) | 100% (35/35) | 0.50 |
| Ratio of leg wound complications to harvested sites | 15.0% (6/40) | 25.8% (8/31) | 0.37 |
| Paresthesia | 4 | 7 | |
| Infection | 1 | 0 |
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