Vein Integrity and Clinical Outcomes - VICO

Contribution To Literature:

The VICO trial showed minimal difference between three techniques for vein harvesting in CABG patients.

Description:

The goal of the trial was to evaluate treatment with open vein harvest compared with endoscopic vein harvest among patients undergoing coronary artery bypass grafting (CABG).

Study Design

  • Randomized
  • Parallel

Patients undergoing CABG were randomized to closed tunnel endoscopic vein harvest (n = 100) versus open tunnel endoscopic vein harvest (n = 100) versus open vein harvest (n = 101).

Closed tunnel endoscopic vein harvest involved a pressurized CO2 tunnel. Open tunnel endoscopic vein harvest involved a nonpressurized CO2 tunnel.

  • Total number of enrollees: 301
  • Duration of follow-up: 48 months
  • Mean patient age: 67 years
  • Percentage female: 18%
  • Percentage with diabetes: 37%

Inclusion criteria:

  • Patients undergoing CABG with one internal mammary artery and at least one saphenous vein bypass graft

Exclusion criteria:

  • Emergency CABG
  • Superficial or varicose long saphenous vein and/or small/thin legs

Principal Findings:

The primary outcome, endothelial integrity in random vein samples, was 85% for closed tunnel endoscopic vein harvest versus 88% for open tunnel endoscopic vein harvest versus 93% for open vein harvest (p < 0.001).

Secondary outcomes:

  • No difference in major adverse cardiac events (MACE) between the three groups up to 48 months
  • Leg wound numbness: 3.0% for closed tunnel endoscopic vein harvest vs. 10.3% for open tunnel endoscopic vein harvest versus 52.5% for open vein harvest (p < 0.001)

Interpretation:

Among patients undergoing CABG, endoscopic vein harvest was associated with a small improvement in endothelial integrity compared with open vein harvest. There was no apparent difference in MACE between the three techniques used for vein harvesting. The incidence of leg wound numbness was lowest for closed tunnel endoscopic vein harvest. In experienced hands, endoscopic vein harvest is a viable technique for CABG.

References:

Krishnamoorthy B, Critchley WR, Thompson AJ, et al. A study comparing vein integrity and clinical outcomes (VICO) in open vein harvesting and two types of endoscopic vein harvesting for coronary artery bypass grafting: the VICO randomised clinical trial. Circulation 2017;Jun 21:[Epub ahead of print].

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Endoscopy, Hypesthesia, Incidence, Mammary Arteries, Tissue and Organ Harvesting, Treatment Outcome


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