Endoscopic saphenous vein harvest for coronary artery bypass grafting
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/ipg343
This guidance replaces previous guidance on endoscopic saphenous vein harvest for coronary artery bypass grafting (interventional procedure guidance 248).
1.1 Current evidence on the efficacy and safety of endoscopic saphenous vein harvest for coronary artery bypass grafting (CABG) is adequate in terms of its advantages over the use of long incisions for healing of lower limb wounds. However, recent evidence has raised concerns about long-term patency of graft conduits harvested by this technique and the possible effects of reduced patency rates on clinical outcomes (including re-intervention, myocardial infarction and death). Therefore this procedure should be used only with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake endoscopic saphenous vein harvest for CABG should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the benefits of minimal access graft harvesting balanced against the possible risks of inferior cardiac clinical outcomes and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.
1.3 Clinicians should enter details about all patients undergoing endoscopic saphenous vein harvest for CABG onto the UK Central Cardiac Audit Database.
1.4 NICE encourages further research into endoscopic saphenous vein harvest for CABG. This could take the form of retrospective data analyses and prospective studies. These studies should address long-term clinical outcomes (including re-intervention, myocardial infarction and death) and graft imaging to demonstrate patency rates of grafts. NICE may review this procedure on publication of further evidence.