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Ann Thorac Surg 2001;72:319-320
© 2001 The Society of Thoracic Surgeons

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Correspondence

Saphenectomy wound complications: fact or fiction

To the Editor

Paletta and colleagues [1] in a recent retrospective analysis attempted to educate cardiac surgeons with respect to the incidence of leg wound complications after saphenectomy for coronary artery bypass grafting. Their analysis, unfortunately, continues to propagate the myth that "these complications (nonmajor) rarely require surgical intervention and represent minor concerns in most patients undergoing coronary artery bypass grafting." They reported an overall 4.5% (145 of 3,525 patients) rate for lower extremity wound complications and emphasized that major leg wound complications requiring further operation occurred in only 0.65% (23 of 3,525 patients). Although detailing major complications after traditional saphenectomy, their report underestimates the overall incidence of leg wound complications due to its retrospective design, failure to define minor complications, and lack of independent, nonsurgeon wound complication evaluation. Furthermore, because primary emphasis was placed on major complications the report minimizes the significant impact minor complications have on patient satisfaction and does not consider the resources expended on outpatient wound management [2, 3]. Two prospective studies by Allen [2] and Utley [4] and their colleagues have evaluated longitudinal saphenectomy wound complications after coronary artery bypass grafting using the same wound complication definition and independent assessment. They reported complication rates of 19% and 24%, respectively.

The conclusion of Paletta and colleagues that "vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site selection" will reduce these complications ignores emerging endoscopic vein harvest technology. In a prospective, randomized comparison of endoscopic versus longitudinal saphenectomy, endoscopic vein harvest was associated with a significant reduction of leg wound complications (4% versus 19%), respectively [2]. On rare occasions, when major complications occur after endoscopic vein harvest (0.1%), wound management is often simplified [5]. Most significantly, traditional saphenectomy is identified as an independent predictor for wound complications and the use of endoscopic vein harvest modifies the impact of diabetes, peripheral vascular disease, female gender, and obesity as risk factors for development of leg wound complications [6].

Endoscopic vein harvest has been criticized for being more time-consuming, more expensive, and without long-term patency follow-up when compared to traditional saphenectomy. Recent studies, however, support the hypothesis that endoscopically harvested saphenous vein is similar both histologically [7] and with respect to patient outcomes at 18 months to vein harvested by a traditional technique [3]. Failure to adopt a less invasive vein harvest technique, based solely on time consideration is no longer defensible.

References

1. Paletta C.E., Huang D.B., Fiore A.C., Swartz M.T., Rilloraza F.L., Gardner J.E. Major leg wound complications after saphenous vein harvest for coronary revascularization. Ann Thorac Surg 2000;70:492-497.
2. Allen K.B., Griffith G.L., Heimansohn D.A., et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg 1998;66:26-32.
3. Allen K.B., Heimansohn D.A., Griffith G.L., et al. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial with 18-month follow-up. Circulation 1999;100(Suppl 18):I93.
4. Utley J.R., Thomason M.E., Wallace D.J., et al. Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg 1989;98:147-149.
5. Allen K.B., Fitzgerald E.B., Heimansohn D.A., et al. Management of closed space infections associated with endoscopic vein harvest. Ann Thorac Surg 2000;69:960-961.
6. Allen K.B., Heimansohn D.A., Robison R.J., et al. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surg Forum 2000;3:325-330.
7. Griffith G.L., Allen K.B., Waller B.F., et al. Endoscopic and traditional saphenous vein harvest: a histologic comparison. Ann Thorac Surg 2000;69:520-523.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Keith B. Allen David A. Heimansohn Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Allen, K. B. Articles by Shaar, C. J. Search for Related Content PubMed Articles by Allen, K. B. Articles by Shaar, C. J. Related Collections Coronary disease Related Article