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Is Endoscopic Vein Harvesting Using "no Touch" Technique Safe For Lower Extremities?
Victor Vaykin, Mikhail Riazanov, Alishir Gamzaev, Anton Maximov, George Bolshuhin, Dmitry Zhiltsov, Alexander Shamatolsky;
B. A. Korolev Specialized Clinical Cardiac Surgery Hospital, Nizhny Novgorod, Russian Federation
BACKGROUND:Despite the growing trend towards performing full arterial revascularization, great saphenous vein remains the most commonly used conduit. Harvesting of vein in a flap with surrounding tissues ("no touch") and its perfusion without dilation allows to achieve high viability of vein as a conduit and maintain patency for a long time, however, causes a significant number of postoperative wound complications. The aim of our study was to compare the clinical and functional state of lower limb after endoscopic vein harvesting in a flap and skeletonized.
METHODS: 234 cases of endoscopic harvesting of great saphenous vein performed in 2018-2020 were analyzed. They were divided into 2 groups: group 1 (n=110) included patients who underwent endoscopic vein harvesting using skeletonized technique, the second group (n=124) included patients whom veins were harvested endoscopically in a flap. Concomitant pathology and other factors affecting the healing process of postoperative wounds were evaluated in both groups, no statistical difference was found.
RESULTS: During the examination in the early postoperative period, 19 complications (17.3%) from the lower limb were revealed in group 1, hematomas of lower leg were detected in 14 cases (12.7%). In addition, there were 18 cases (16.4%) of acute lymphovenous insufficiency, manifested by edema up to the ankle. 25 complications (20.2%) in group 2 were diagnosed. Acute lymphovenous insufficiency occurred in 23 cases (18.5%), with edema spreading up to ankle. 15 patients (12.1%) had hematomas. However, in group 2 92 patients (74.2%) had neuropathies, manifested by hypesthesia in the area of vein allocation in the lower leg, which was absent in group 1.
CONCLUSIONS:Endoscopic harvesting of vein in a flap allows to minimize surgical trauma and procure a conduit with a good prognosis of functioning, corresponding to modern standards of revascularization. The number of complications is small, equals to endoscopic harvesting of skeletonized vein and does not have any significant impact on the rehabilitation of patients. However, due to the fact that vein harvests in a flap together with n. Saphenous, there are frequent cases of decreasing of skin sensitivity in the lower leg.
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