Risk Factors for Leg Wound Complications Following Endoscopic Versus Traditional Saphenous Vein Harvesting

(#2000-5999 ... June 8, 2000)

Keith B. Allen, MD, David A Heimansohn, MD, Robert J. Robison, MD, John J. Schier, MD, Gary L. Griffith, MD, Edward B. Fitzgerald, MD, John H. Isch, MD, Simon Abraham, MD, Carl J. Shaar, PhD

Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis, IN

The Heart Surgery Forum #2000-5999 3 (4):325-330, 2000

ABSTRACT

Background: Risk factors for leg wound complications following traditional saphenectomy have included: obesity, diabetes, female gender, anemia, age, and peripheral vascular disease. Use of an endoscopic saphenectomy technique may modify the risk factor profile associated with a traditional longitudinal incision.

Methods: From September 1996 to May 1999, 276 consecutive patients who underwent elective isolated coronary artery bypass grafting performed by a single surgeon (K.B.A.) had their greater saphenous vein harvested endoscopically. During the period from January 1999 to May 1999, the surgical records of 643 patients who underwent the same operation and had a traditional longitudinal saphenectomy were reviewed for postoperative leg wound complications. Group demographics were similar regarding preoperative risk stratification and traditionally identified wound complication risk factors (diabetes, gender, obesity, preoperative anemia, and peripheral vascular disease). Leg wound complications were defined as: hematoma, dehiscence, cellulitis, necrosis, or abscess requiring dressing changes, antibiotics and/or debridement prior to complete epithelialization. Follow-up was 100% at six weeks.

Results: Leg wound complications following endoscopic harvest occurred in 3% (9/276) of patients versus 17% (110/643) of traditional harvest patients (p<0.0001). No univariate risk factors for wound complications were associated with endoscopic saphenectomy. Univariate predictors of wound complications following traditional saphenectomy included: diabetes (p=0.001), obesity (p=0.0005), and female gender (p=0.005). Multivariable risk factors for leg wound complications following saphenectomy were traditional harvest technique (OR 7.56, CI 3.8-17.2, p<0.0001), diabetes (OR 2.10, CI 1.4-3.2, p=0.0006) and obesity (OR 1.82, CI 1.2-2.8, p=0.007).

Conclusions: Traditional longitudinal saphenectomy is a multivariable risk factor for development of leg wound complications. Endoscopic saphenectomy modifies the risk factor profile for wound complications and should be the standard of care, particularly for obese and/or diabetic patients who require venous conduit during coronary artery bypass grafting.

AUTHOR/ARTICLE INFORMATION

Presented at the Third Annual Meeting of the International Society for Minimally Invasive Cardiac Surgery, Atlanta, GA, June 8-10, 2000.

Address correspondence and reprint requests to: Keith B. Allen, MD, 8333 Naab Road, Suite 300, Indianapolis, IN 46260, Phone: (317) 338-3551, Fax: (317) 338-9209, Email: cshaar@iquest.net

Appendix

Heartbase Variables

Patient characteristics recorded in the Heartbase Data System of the Indiana Heart Institute and reviewed for identification of preoperative variables associated with postoperative leg wound complications.

Traditional SV harvest
Endoscopic SV harvest
Obesity
Diabetes
Gender
Hematocrit
Peripheral vascular disease
Prior peripheral vascular surgery
Other vascular surgery
Claudication
Age
History of smoking
Current smoker
Renal insufficiency
Hypertension
Congestive heart failure
Prior percutaneous transluminal coronary angioplasty
Prior CABG
Carotid disease
History of stroke
Ejection fraction
White blood cell count
Procedure status (elective, urgent, emergent)
Valvular heart disease
Angina class
Current myocardial infarction
Prior myocardial infarction
Hypercholesterolemia
Cardiomyopathy
Concomitant procedures