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Objective: The saphenous vein continues to be the most commonly used bypass conduit for coronary surgery. Endoscopic techniques achieve an improvement in the outcomes of leg incisions. Endoscopic procedure is time consuming and is a definite added cost due to the expense of the equipments. In order to avoid any extra-cost of CABG surgery we developped a nondisposable device to hallow saphenous vein minimal invasive harvesting rapid, cheap, efficace and safe.
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Giuseppe D'Arrigo1, Gaetano Mauceri1, Filippo Fraggetta1, Massimo Lemma2, Carlo Antona2, Alberto Lomeo1.
1Cardiovascular Dept., Ospedale Cannizzaro, Catania, Italy, 2Cardiovascular Dept., Ospedale Luigi Sacco, Milano, Italy.
Methods: Between November 2003 and July 2005 we have treated 134 patients for CABG surgery. The instrumentation consisted of 2 coaxial cylinders (CSD). Posteriorly to the patella, a 3 cm incision was made. The GSV was exposed, interrupted. A steel wire was introduced through the GSV and advanced until the saphenofemoral junction. At that level a second incision was made, the vein isolated. The CSD was advanced proximally with rotary movements in order to achieve the harvesting of the vein. The wire was withdrawn from the GSV. All specimens of discharged vien were processed for histological evaluation, stained with hematoxylin and eosin, Verhoeff elastic, Gomori trichrome. Immunohistochemical studies with CD 34 (clone QBEND 10) and factor VIII (von Willebrand factor protein) were performed. A grading system (by Griffith) estimated the percent disruption of each histologic structure and was scored according the scale: 0 (intact or no disruption), 1 (<10%), 2 (10 to 25%), 3 (25 to 50%), and 4 (>50%).
Results: A total of 378 vein segments have been studied. The results of the study was: 93% grade 0; 2% grade 1; 3.5% grade 2; 0% grade 3; 1.5% grade 4. The incidence of LWHD was 0.76%: 1 case of a superficial hematoma. No post operative pain. Good cosmetic results.
Conclusions: Minimally invasive vein harvesting is less traumatic to the extremity with fewer complications and superior patient satisfaction. Although commercial disposable systems are now available to allow minimally invasive harvesting of the saphenous vein, we think our CSD can be safely used and at a much reduced costs.
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