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Vein Removal Method Linked to Bypass Results

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Endoscopic harvesting, which uses a one- or two-inch incision to remove a saphenous vein from a leg, is used in 70 percent of the 450,000 coronary bypass operations done annually in the United States. Conventional surgery, which requires a much longer incision, is used in the other 30 percent of cases. Endoscopic harvesting is popular among surgeons and people having bypasses because it virtually eliminates the risk of infection, excess bleeding and other complications associated with conventional removal.

The journal report does not discuss those advantages. Instead, it focuses on the greater rate of graft failure (46.7 percent versus 38 percent at 18 months), death or heart attack (9.3 percent versus 7.6 percent at three years) and deaths (7.4 percent versus 5.8 percent at three years) seen in those who had endoscopic harvesting.

"This has changed the conversation I have with patients," said Alexander, who does not perform bypass surgery but refers patients for the procedure. "Now we have to be balancing the known short-term benefits of endoscopic harvesting with the long-term risk."