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Khorfan R, Vely A, Batool F, Jackson MW, Hance ML, Jones DJ, Napier JA, Heidenreich MJ, Aziz A. Ten-year experience of infrainguinal bypass with endoscopic vein harvest. Vascular 2024; 32:612-618. [PMID: 36446034 DOI: 10.1177/17085381221142213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES There is conflicting data comparing minimally invasive vein harvest (MIVH) using endoscopic technique and open vein harvest (OVH) in terms of bypass patency, wound infection incidence, and patient morbidity. Our institution has performed MIVH since 2003 for peripheral bypass procedures with a consistent team of specialized endoscopic vein harvesters. This study reviewed the major outcomes of MIVH infrainguinal bypass at our institution given a predominant cohort of critical limb ischemia. METHODS We performed a 10-year, retrospective, single-institution review from January 2005 to December 2014, identifying all patients undergoing MIVH for obstructive infrainguinal disease. Primary outcomes were primary patency, operative time, intraoperative complications, surgical site infection (SSI), and freedom from amputation. RESULTS A total of 289 patients (70% male) underwent MIVH infrainguinal bypass at an average age of 68 ± 12 years old, an obesity prevalence of 28%, and with critical limb ischemia in 81% of the patient cohort (20% rest pain, 61% tissue loss/gangrene). Ninety-four percent of patients had no intraoperative complications, 2.5% had adverse cardiac or technical complications, and 4.2% of patients required transfusion. Average operative time was 4.2 h. Femoral-popliteal TASC classification C and D constituted 80% of our patient cohort. At the last follow-up, toe pressures had increased from 30 ± 30 to 62 ± 40 mmHg (p < 0.0001). Primary bypass patency in the first 30 days was 95%. SSI incidence requiring surgical treatment was only 6%. Our median length of stay was 4.0 days, with median intravenous narcotic use of 1 day. In addition, 77% of patients returned to their baseline mobility at first follow-up (median 19 days), and 83% of patients had freedom from amputation at last follow-up (median 820 days). CONCLUSIONS In a center with experience in MIVH and a consistent group of experienced endoscopic vein harvesters, MIVH bypass has excellent patency, low surgical site infection, short length of stay, and prompt return to baseline mobility.
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Affiliation(s)
- Rhami Khorfan
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Aela Vely
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Farwa Batool
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Miles W Jackson
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - M LaWaun Hance
- Section of Cardiac and Thoracic Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Diane J Jones
- Section of Cardiac and Thoracic Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Jarred A Napier
- Department of Surgery, Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Michael J Heidenreich
- Section of Vascular Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | - Abdulhameed Aziz
- Section of Vascular Surgery, Department of Surgery, Trinity Health Saint Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
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Biroš E, Staffa R, Novotný T, Krejčí M, Velecký L, Skotáková M. Long-Term Comparison of Endoscopic Versus Open Saphenous Vein Harvest for Femoral-to-Popliteal Artery Bypass. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Ilio-Deep Femoral Bypass – an Alternative Treatment Strategy to Critical Limb Ischemia (CLI). JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Critical limb ischemia is considered the most severe form of peripheral artery disease. High morbidity and mortality rates are associated with this pathology due to poor economic management of complications. Case summary: A 68-year-old female patient underwent a routine Doppler ultrasound which revealed the obstruction of both the common and superficial right femoral arteries, as well as the right deep femoral artery. In this case, an iliofemoral bypass was performed using the right deep femoral artery as the outflow artery. Conclusion: Revascularization of the deep femoral artery has a reasonable chance of preserving the ischemic lower limb whenever the common and superficial femoral arteries suffer major atherosclerotic blockages.
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Guo Q, Huang B, Zhao J. Systematic review and meta-analysis of saphenous vein harvesting and grafting for lower extremity arterial bypass. J Vasc Surg 2020; 73:1075-1086.e4. [PMID: 33091517 DOI: 10.1016/j.jvs.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In the present systematic review and meta-analysis, we compared the short- and long-term outcomes of different harvesting and grafting techniques in patients undergoing lower extremity arterial bypass. METHODS We searched multiple electronic databases (up to December 1, 2019) for comparative trials investigating different harvesting and bypass grafting techniques. RESULTS We identified a total of 37 studies for our review. Skip incision harvesting showed a similar high primary patency rate (Peto odds ratio [OR], 0.93; 95% confidence interval [CI], 0.83-1.04; P = .20) with continuous incision harvesting and comparable low wound complication rates (relative risk, 1.55; 95% CI, 0.91-2.66; P = .11) with endoscopic harvesting. In situ bypass grafting a long-term patency similar to that of reversed grafting (Peto OR, 1.01; 95% CI, 0.75-1.37; P = .93). However, for femoropopliteal bypass, the reversed bypass grafting group had significantly lower 2-year (Peto OR, 0.63; 95% CI, 0.52-0.78; P < .001) and 5-year (Peto OR, 0.70; 95% CI, 0.50-0.98; P = .04) failure rates compared with the in situ bypass grafting group. For infrapopliteal bypass, the in situ bypass grafting group had significantly lower 1-year (Peto OR, 1.54; 95% CI, 1.04-2.28; P = .03), 2-year (Peto OR, 1.52; 95% CI, 1.15-2.02; P = .003), and 3-year (Peto OR, 2.14; 95% CI, 1.13-4.05; P = .02) failure rates. CONCLUSIONS Skip incision harvesting can be considered the first-line harvesting strategy. For patients undergoing femoropopliteal bypass, reversed bypass grafting seems to result in better long-term patency. In contrast, for those undergoing infrapopliteal bypass, in situ bypass grafting resulted in superior long-term patency.
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Affiliation(s)
- Qiang Guo
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Kronick M, Liem TK, Jung E, Abraham CZ, Moneta GL, Landry GJ. Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses. J Vasc Surg 2019; 70:1534-1542. [DOI: 10.1016/j.jvs.2019.02.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/19/2019] [Indexed: 10/26/2022]
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Mirza AK, Stauffer K, Fleming MD, De Martino R, Oderich G, Kalra M, Gloviczki P, Bower T. Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass. J Vasc Surg 2018; 67:1199-1206. [DOI: 10.1016/j.jvs.2017.08.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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Wheeler AR, Kendrick DE, Allemang MT, Gosling AF, Kim AH, Hausladen A, Kashyap VS. Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques. Ann Vasc Surg 2017; 44:317-324. [PMID: 28495542 DOI: 10.1016/j.avsg.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Endoscopic vein harvest for lower extremity arterial bypass grafting has been questioned due to concern for endothelial damage during procurement. We sought to compare nitric oxide (NO)-mediated endothelial-dependent relaxation (EDR) in vein segments harvested using open surgical techniques (OH) versus endoscopic vein harvest (EH) techniques. METHODS Saphenous vein segments were harvested for lower extremity bypass, and a single, minimally handled section of saphenous vein, free of branches, was taken from the end of the graft. Four 4-mm venous ring segments were then cut and mounted on force transducers. Segments were mounted in 37° oxygenated Krebs-Henseleit solution and maximally contracted using KCl. Individual ring segments that did not react to KCl were excluded from the study. Norepinephrine (NE) was used to achieve submaximal contraction. EDR was determined using increasing concentrations of bradykinin (BDK). Endothelial-independent relaxation (EIR) was confirmed using sodium nitroprusside. Two-way analysis of variance (ANOVA) was used to analyze differences between harvest techniques across BDK concentration and a Student's t-test was used to analyze single comparisons. RESULTS Vein segments harvested from patients (n = 13) led to 28 viable rings that exhibited a positive reaction to KCl (11 rings; 5 patients EH vs. 17 rings; 8 patients OH). Both vein groups achieved moderate relaxation to maximal BDK concentration, [10-6 M]; (49.5% EH vs. 40.55% OH, P = 0.270). Analysis by 2-way ANOVA for mean % relaxation for BDK concentration [10-11-10-6 M] showed improved EDR in EH samples compared with OH (P = 0.029). Mean nitrite/nitrate (NO(x)) tissue bath concentration measurements post-BDK were 139.8 nM (EH) vs. 97.2 nM (OH; P = 0.264). Histology and positive factor VIII immunohistochemistry staining provided evidence for the presence of intact endothelium in our sample segments. EIR was preserved and was similar in the two groups. CONCLUSIONS Endothelial function is preserved when utilizing endoscopic harvesting techniques. The advantages of minimally invasive vein procurement for lower extremity bypass can be obtained without concern for damaging venous endothelium.
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Affiliation(s)
- Adam R Wheeler
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | | | - Matt T Allemang
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Andre F Gosling
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Ann H Kim
- Department of Vascular Surgery, University Hospitals, Cleveland, OH
| | - Alfred Hausladen
- Institute for Transformative Molecular Medicine, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Vikram S Kashyap
- Department of Vascular Surgery, University Hospitals, Cleveland, OH.
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Endoscopic vein harvest does not negatively affect patency of great saphenous vein lower extremity bypass. J Vasc Surg 2016; 63:1546-54. [DOI: 10.1016/j.jvs.2016.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/08/2016] [Indexed: 11/23/2022]
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Peinado Cebrián J, Flores Herrero Á, Salgado Lopetegui CL, Lamarca Mendoza MP, Montoya Ching R, Seco SE, Leal Lorenzo JI, Gil Sales J, Pérez-Grueso AO. Comparison of Bypass with Endoscopically Harvested Internal Saphenous Vein versus Bypass with Surgically Harvested Internal Saphenous Vein for Lower Limb Arterial Disease. Ann Vasc Surg 2015; 29:1353-62. [DOI: 10.1016/j.avsg.2015.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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10
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Vein harvesting technique for infrainguinal arterial bypass with great saphenous vein and its association with surgical site infection and graft patency. J Vasc Surg 2015; 61:1264-71.e2. [PMID: 25659457 DOI: 10.1016/j.jvs.2014.12.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/17/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the association of vein harvesting technique (VHT) with surgical site infection (SSI) and graft patency after infrainguinal arterial bypass. METHODS The Vascular Quality Initiative database was used to review VHT of all patients undergoing single-segment great saphenous vein graft infrainguinal arterial bypass from 2003 to 2013. Patients were divided into three groups according to the VHT used (continuous incision, skip incision, and endoscopic). Multinomial logistic regression was performed to estimate propensity scores for each treatment group. Propensity score adjustment was included in multivariable analysis of the primary outcomes: SSI and graft primary patency. RESULTS From 2003 to 2013, 5066 patients underwent single-segment great saphenous vein graft infrainguinal bypass. The VHT was continuous incision in 48.6%, skip incision in 39.7%, and endoscopic in 12.7%. SSI rates did not differ significantly among the groups (continuous, 4.7%; skip, 4.0%; endoscopic, 3.4%; P = .278). On multivariable analysis, there was no difference in discharge primary patency between the three groups. At 1 year, primary patency rates were 69.5% for continuous, 73.0% for skip, and 58.6% for endoscopic (P < .001). After multivariable analysis, endoscopic vein harvest was independently associated with higher 1-year primary patency loss compared with both continuous (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.05-1.74; P = .020) and skip (HR, 1.53; 95% CI, 1.18-2.00; P = .002). There was no significant difference in 1-year primary patency loss between continuous and skip techniques (HR, 0.88; 95% CI, 0.73-1.05; P = .170). CONCLUSIONS No association between the choice of VHT and the development of SSI after infrainguinal arterial bypass was identified in the Vascular Quality Initiative population. Endoscopic VHT was associated with significantly reduced 1-year primary patency rate compared with both continuous and skip techniques.
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Eid RE, Wang L, Kuzman M, Abu-Hamad G, Singh M, Marone LK, Leers SA, Chaer RA. Endoscopic versus open saphenous vein graft harvest for lower extremity bypass in critical limb ischemia. J Vasc Surg 2014; 59:136-44. [PMID: 24370082 DOI: 10.1016/j.jvs.2013.06.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Endoscopic vein harvest (EVH) has been demonstrated to improve early morbidity when compared with conventional open vein harvest (OVH) technique for infrainguinal bypass surgery. However, recent literature suggests conflicting results regarding mid- and long-term patency with EVH. The purpose of this study is to compare graft patency between harvest techniques specifically in patients with critical limb ischemia. METHODS This retrospective study compared two groups of patients (EVH = 39 and OVH = 49) undergoing lower extremity revascularization from January 2009 to December 2011. Outcome measures included patency rates, postoperative complications, and wound infection. Graft patency was assessed using Kaplan-Meier curves. RESULTS Both groups were matched for demographics and indications for bypass (critical limb ischemia). Median follow-up was 22 months. There was a significant reduction in the incidence of wound infection at the vein harvest site in the EVH group (OVH = 20%; EVH = 0%; P < .001), nevertheless, the difference was not significant when only the anastomotic sites were included (OVH = 12.2%; EVH = 15.4%; P = .43). The hospital length of stay was comparable between the two groups (EVH = 8.73 ± 9.69; OVH = 6.35 ± 3.28; P = .26) with no significant difference in the recovery time. Primary graft patency rate was 43.2% in the EVH group and 69.4% in the OVH group (P = .007) at 3 years. The most common reason for loss of primary patency was graft occlusion (61.5%) in the OVH group and vein graft stenosis (54.5%) in the EVH group. The average number of vascular reinterventions per bypass graft was significantly lower in the OVH group compared with the EVH group (OVH = 0.37; EVH = 1.28; P < .001). CONCLUSIONS Our findings demonstrate inferior primary patency when using the technique of EVH. Additionally, we identified a significantly higher rate of reintervention in the EVH cohort as well as a higher rate of vein graft body stenosis. However, EVH was associated with a decreased rate of wound complications with similar limb salvage and secondary patency rates when compared to OVH. EVH should therefore be selectively utilized in patients at high risk for wound complications.
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Affiliation(s)
- Raymond E Eid
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Li Wang
- University of Pittsburgh, Clinical Translational Science Institute, Pittsburgh, Pa
| | - Michael Kuzman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ghassan Abu-Hamad
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael Singh
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Luke K Marone
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Steven A Leers
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Santo VJ, Dargon PT, Azarbal AF, Liem TK, Mitchell EL, Moneta GL, Landry GJ. Open versus endoscopic great saphenous vein harvest for lower extremity revascularization of critical limb ischemia. J Vasc Surg 2014; 59:427-34. [DOI: 10.1016/j.jvs.2013.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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El-Sayed HF. Bypass surgery for lower extremity limb salvage: vein bypass. Methodist Debakey Cardiovasc J 2013; 8:37-42. [PMID: 23342187 DOI: 10.14797/mdcj-8-4-37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Bypass surgery for limb salvage in cases of chronic limb ischemia is a well-established treatment modality. Use of an autogenous vein provides the best conduit for infrainguinal arterial bypass procedures, particularly for bypass to the infrapopliteal arteries. In this article, we discuss infrainguinal vein bypass surgery including indications, perioperative care, and long-term follow up. We also discuss the outcomes of the procedure with regard to patient survival and limb salvage. The autogenous vein continues to be the best available conduit with the highest patency rate and the best treatment option. Compared to all other revascularization options for infrainguinal disease, the vein bypass has the best limb salvage and long-term survival in patients appropriately selected for the procedure.
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Affiliation(s)
- Hosam F El-Sayed
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
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Wartman SM, Woo K, Herscu G, Morell M, Nikolian V, Manzur M, Weaver FA. Endoscopic vein harvest for infrainguinal arterial bypass. J Vasc Surg 2013; 57:1489-94. [DOI: 10.1016/j.jvs.2012.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
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Rachwalik M, Płonek T, Kustrzycki W, Szyber P, Pawłowski S, Goździk W. The use of minimally invasive videoscopic technique in large vessel and cardiac surgery. Does the potentially increased difficulty bring benefits to the patient? Wideochir Inne Tech Maloinwazyjne 2013; 8:86-9. [PMID: 23630560 PMCID: PMC3627157 DOI: 10.5114/wiitm.2011.31596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 05/28/2012] [Accepted: 07/07/2012] [Indexed: 11/27/2022] Open
Abstract
We present the clinical case of a 63-year-old patient who underwent in the Department of Cardiac Surgery implantation of an aorto-bifemoral graft prosthesis and coronary artery bypass revascularization with application of less invasive off-pump technique. Graft selection (arterial grafts, venous grafts) is very important during qualification for coronary artery bypass revascularization. Minimally invasive saphenous vein harvesting was performed during the presented case. The endoscopic technique of vein harvesting is a relatively rarely applied technique during myocardial revascularization surgery. The concept of minimally invasive videoscopic technique is presented. There is a discussion on why the team decided to prolong duration of the case consisting of two major operations performed simultaneously. Minimally invasive videoscopic technique may have a significant positive impact on postoperative outcome in a selected group of patients.
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Affiliation(s)
- Maciej Rachwalik
- Department and Clinic of Cardiac Surgery, Medical University of Wrocław, Poland
| | - Tomasz Płonek
- Department and Clinic of Cardiac Surgery, Medical University of Wrocław, Poland
| | - Wojciech Kustrzycki
- Department and Clinic of Cardiac Surgery, Medical University of Wrocław, Poland
| | - Przemysław Szyber
- Department and Clinic of Vascular, General and Transplantation Surgery, Medical University of Wrocław, Poland
| | - Stanisław Pawłowski
- Department and Clinic of Vascular, General and Transplantation Surgery, Medical University of Wrocław, Poland
| | - Waldemar Goździk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Wrocław, Poland
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