July 15, 2009 / 9:15 PM / 10 years ago

Endoscopic technique yields poorer veins for heart

BOSTON (Reuters) - Using an endoscope to remove leg veins for heart bypass surgery appears to damage the veins and makes patients 52 percent more likely to die within three years, doctors reported on Wednesday.

A doctor performs an arthroscopy procedure on a knee in this undated handout photo. REUTERS/Newscom/Handout

Although the technique is meant to be less invasive and gentler, it may in fact damage the vein and lead to heart attacks, the researchers reported in the New England Journal of Medicine.

About 70 percent of bypass patients now have their leg vein removed endoscopically, in part because it produces much less scarring and infection to the leg than the traditional method, known as “open harvesting,” in which the vein is taken by directly cutting along a stretch of the leg.

Endoscopes are little cameras that can be inserted, sometimes with surgical instruments, via a small incision in the skin. They are widely used for a range of procedures and have been used for vein harvesting for 13 years.

But the study of 3,000 patients found veins removed by the endoscopic technique were significantly more likely to become clogged within a year or so.

“It’s not gentle,” said Dr. John Alexander of Duke University Medical Center in Durham, North Carolina, who led the study. “There’s a fair amount of tugging that will vary case by case. It’s certainly more traumatic to the vein than open harvesting.”

At the 12- to 18-month mark, 47 percent of the patients had at least one of their bypass grafts fail, versus 38 percent for whom the blood vessels were removed by the older method. Most patients had two or three grafts.

Three years after the heart surgery, the risk of death or a non-fatal heart attack was 38 percent higher among the patients whose leg vein was removed endoscopically. The death rate alone was 52 percent higher — 128 of the 1,753 in the endoscopic group died versus 71 of the 1,247 who had open harvesting.

“Open harvesting, though more invasive and associated with more wound complications, may be less traumatic to the vein and could result in a better conduit,” Alexander and colleagues wrote in their report.

“I think it will generate a lot of discussion and that will be healthy,” Alexander said in a telephone interview. “It’s important that doctors and patients weigh these long-term risks with the really-well-known short-term benefits.”

When the pros and cons are explained to his patients, most still choose the endoscopic technique, he said, worrying less about the long-term risks than the short-term benefits.

“It’s a huge service to patients in terms of preventing wound complications and long scars, reducing the pain and length of stay in the hospital, and improving patient satisfaction. So there are real advantages to it,” he said.

Two companies, Datascope, now owned by Swedish-based Getinge AB, and Boston Scientific Corp in Massachusetts, make devices for endoscopic harvesting.

“My hope is that this will lead people to reassess exactly how we’re doing endoscopic harvesting and lead to better techniques for doing it. It’s not that it’s all the same or that it couldn’t be improved,” Alexander said.

Editing by Maggie Fox and Todd Eastham

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