Minimally invasive long saphenous vein harvesting using a laryngoscope.

BACKGROUND: Traditional open incisions for long saphenous vein (LSV) harvesting are common sources of post operative complications after coronary artery bypass grafting (CABG). To reduce pain and wound healing complications, minimally invasive harvesting techniques are being developed. We have investigated the use of a conventional laryngoscope for cost effective saphenous removal using short incisions and long subcutaneous tunnels. METHODS: The LSV was exposed through small incisions connected by long subcutaneous tunnels. Soft tissue retraction, visualization and illumination were provided by a sterilized laryngoscope with a #3 or #4 Macintosh blade. Dissection was performed with standard instruments while branch ligation was performed with vascular clips. Thirty two patients undergoing CABG between October 1997 and January 1998 underwent minimally invasive vein harvesting assisted by a laryngoscope. Clinical outcomes were evaluated. RESULTS: There were 27 males and 5 females with a mean age of 62.6 +/- 9.3 years in this study. Adequate saphenous vein was removed in 29 of 32 cases. (In three patients, the vein was so superficial that an open incision proved easier). The length of harvested conduit averaged 38.2 +/- 11.01 centimeters (21-55 centimeters). Harvesting time average 37.1 minutes (+/-10.8 minutes; range from 20 to 62 minutes). Postoperatively, There were no wound dehiscences, infections, cellulitis, or major hematomas. Pain and leg edema were considerably less than with traditional open harvest. CONCLUSIONS: Minimally invasive vein harvesting is less traumatic to the extremity with fewer complications and superior patient satisfaction. Although commercial disposable systems are now available to permit minimally invasive harvesting of the saphenous vein, a conventional laryngoscope can be used with much reduced costs.

Paraplegia as a result of intra-aortic balloon counterpulsation.

A case of paraplegia after a perioperative intra-aortic balloon support is presented. This rare and devastating complication is the twelfth reported in international literature.

Aspergillus prosthetic valve endocarditis.

A 66-year-old man developed Aspergillus fumigatus endocarditis, complicated by an aortic root abscess 9 months after his aortic valve replacement with a Carpentier Edwards xenograft. The aortic root was replaced with an antibiotic-treated fresh homograft and anti-fungal chemotherapy commenced 24 hours later. One month after this he developed a retrosternal pseudo-aneurysm of the ascending aorta. At re-operation the homograft was heavily infected with fungal growths and the patient was considered inoperable. This case is an example of a rare condition complicating cardiac valve prosthesis which still has a very poor prognosis, despite any surgical and chemotherapeutic efforts.

Castleman's disease arising from the intercostal space.

A 27-year-old woman was investigated for a tumour of the posterior chest wall. This was excised surgically and histologically it proved to be a hyaline vascular type of angiofollicular lymphoid hyperplasia or Castleman's disease. This is the third case from the literature of such a tumour arising from the intercostal space. Surgical excision has been proved curative until now with no recurrence.