ESVH has been described as a safe, effective and cost-containing method (1, 2). The advantages include: less wound complications and increased patient comfort. These advantages would ultimately lead to cost-containment through reduced length-of-stay and treatment expenses.
We have used ESVH in 100 consecutive and non-selected patients requiring coronary bypass surgery using venous grafts. Morbidity related to saphenous vein prelevation was recorded and compared to a non-selected historical control group (N=905). Wound complications in the donor leg occurred in 1 of 100 patient (1%) of the study group as compared to 5.6% of patients in the control group (p=0.047). These results seem to confirm earlier claims of benefit for this procedure (1,2). However, since the disposable equipment adds significantly to the total cost of the procedure, we have tried to identify high risk groups that may especially benefit by using ESVH. Diabetes and patient gender seem to be highly predictive for developing wound complications in the control group. Diabetes, regardless the gender, doubles the risk (p=0.03). Female patients with diabetes have a 23 fold higher
chance (p<0.0001) of developing such complications as compared to their male counterparts.
We conclude that ESVH is a promising method resulting in a decreased morbidity in highrisk patients. The cost of the equipment requires further investigation in order to assess cost-effectiveness. Until then, we believe that generalised use is not justified.
1 Crouch J. et al. Endoscopic saphenous vein harvesting for coronary artery bypass grafting. 6th World Congress of Endoscopic Surgery 1998.
2 Chin A. et al. Endoscopic cardiovascular vessel harvesting. 6th World Congress of Endoscopic Surgery 1998.