Leg Wound Infection after Coronary Artery Bypass Grafting: A Meta-Analysis Comparing Minimally Invasive Versus Conventional Vein Harvesting
The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom. The Annals of Thoracic Surgery
(Impact Factor: 3.85).
01/2004; 76(6):2141-6. DOI: 10.1016/S0003-4975(03)01435-8
The great saphenous vein remains the most commonly harvested conduit for revascularization in coronary artery bypass grafting (CABG). Our aim is to compare minimally invasive vein harvest techniques to conventional vein harvest with regards to leg wound infection rates. A meta-analysis of identified randomized controlled trials, reporting a comparison between the two techniques published between 1965 and 2002, was undertaken. The outcome of interest was leg wound infection. Fourteen randomized studies were identified and included in the meta-analysis. Our study revealed that wound infection was significantly lower in the minimally invasive vein harvest group (odds ratio 0.22 with 95% confidence intervals of 0.14 to 0.34). Our study suggests that using minimally invasive techniques might reduce leg wound infection rate following great saphenous vein harvesting for CABG. Further research is required to evaluate the potential benefits of minimally invasive vein harvesting techniques on the cost of postoperative care and quality of the harvested vein.
Available from: Nader D Nader
- "Endoscopic vein harvesting for coronary artery bypass grafting has gained increasing popularity as a minimally invasive approach to harvest venous conduits. This new technique appears to be safer, less traumatic, and more economical than conventional open vein harvesting [1,2]. However, massive carbon dioxide (CO2) embolisms caused by endoscopic vein harvesting have been reported [3-5]. "
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ABSTRACT: A carbon dioxide (CO(2)) embolism during endoscopic vein harvesting is a rare but potentially fatal complication. Early and accurate diagnosis is crucial for limiting the extent of the embolism and stabilizing the resulting cardiovascular compromise. We report a case of CO(2) embolization during endoscopic vein harvesting. Transesophageal echocardiography was instrumental in the diagnosis and management of this patient by further improving the decision making process, which resulted in the best outcome. Mid-esophageal bicaval view is the best view to determine whether a CO(2) embolism is coming from the upper or lower extremities.
Available from: PubMed Central
- "It is assumed that EVH reduces the number of donor-site infections because it causes less trauma to the surrounding tissue, preserves tissue perfusion, and is less likely to create vital tissue flaps . A meta-analysis from 2003 included all available randomised controlled trials that investigated the incidence of donor-site infections (drainage of pus from the wound, positive wound cultures, and requirement for additional treatment surgical or antibiotic treatment) . Eleven randomised controlled trials, with in total 1156 patients had used endoscopic techniques. "
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ABSTRACT: Conventional open harvest of the great saphenous vein (GSV) during CABG results in approximately 7% donor-site complications. Using endoscopic vein harvesting (EVH) the full GSV length can be harvested through a 3 cm incision. This nonsystematic review discusses several key issues concerning EVH, based on an extensive Pubmed search. Found studies show that EVH results in reduced number of wound complications, less postoperative pain, earlier postoperative mobilisation, reduced length of hospital stay, and is more cost-effective. Initial studies did not find significant differences in graft histology, patency, or clinical outcome. However, in 2009 convincing evidence of inferior histological graft properties became available. Furthermore, an observational study showed that EVH resulted in significantly more graft stenosis, was associated with higher mortality, more myocard infarction, and more reinterventions. Most recent publications could not confirm these findings, however larger randomised controlled trials focusing on graft quality are being awaited.
Available from: Mehmet Ates
- "The incidence of leg wound infection between studies ranged from 1% to 42%, the average incidence of leg wound infection after vein harvesting was 12%. (Athanasiou et al. 2003). Seven of the patients (5.6%) had infection at the site of incision during their first follow up visit. "
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ABSTRACT: Our aim was to investigate the efficiency of the keyhole transposed brachiobasilic technique in patients with diabetes mellitus and compare the effect of different arteriovenous fistula techniques on the development of complications.
Thirty-eight diabetic, chronic renal failure patients (group 1) had transposed brachiobasilic arteriovenous fistula creations, and 49 diabetic patients (group 2) had other types of fistula creations and histories of multiple fistula attempts. The 2 groups were compared for age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, arteriovenous fistula patency, and possible complications.
The 2 groups were not different statistically regarding the demographic data including age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, and mean operation time. The median follow-up after surgery in both groups was 8 months. The primary patency in group 1 was 97.4% in the early period (6 weeks after surgery) and 94.7% in the late period (mean duration of 8 months after surgery). In the second group, these rates were 73% and 62%, respectively (P < .05). The secondary patency rates were 84.2% in group 1 and 53% in group 2 (P < .05). In group 2, the primary and secondary patencies of brachiocephalic and radiocephalic fistulas were significantly lower than the patencies of group 1. The incidence of complications was significantly less in group 1 than in group 2 (P < .05).
Although the groups were small in size, the success rate with the keyhole transposed brachiobasilic technique in patients with diabetes was extremely gratifying, and this report can be considered to document the first attempt of a hemodialysis-access procedure.
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