Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

Also called: EVH, Minimally Invasive Vein Harvesting

Summary

During coronary artery bypass graft surgery, a surgeon takes a segment of a healthy blood vessel (an artery or vein) from another part of the body and uses it to create a detour or bypass around the blocked portion of the coronary artery. That process is called vein harvesting. Traditionally, vein harvesting is accomplished through a lengthy surgical incision in the leg. However, a less invasive method called endoscopic vein harvesting (EVH) is becoming more common and is the preferred method of vein harvesting among centers that are properly equipped. Traditional vein harvesting requires an incision to remove the blood vessel being used for the bypass graft, leaving the patient with a long scar. By contrast, EVH requires one to three small incisions, each less than 1 inch in length. A special video camera (called an endoscope) is then used to allow the physician to clearly view the vein harvesting. In addition to avoiding a scar, patients undergoing EVH are also less likely to experience complications and usually have shorter recovery times. Because of these advantages, more bypass procedures are being performed using endoscopic vein harvesting. Most people who require a bypass operation are candidates for EVH.

About endoscopic vein harvesting

Endoscopic vein harvesting (EVH) is a minimally invasive procedure performed to extract the saphenous vein from the leg – a blood vessel commonly chosen for a bypass graft. The procedure is part of conorary artery bypass graft (CABG) surgery, which is performed to bypass one or more blocked coronary arteries and restore oxygen-rich blood flow to the heart. In CABG, a segment of blood vessel is harvested (taken from another part of the body) and used to create a detour around the blocked artery. The most commonly used conduits include an artery from behind the sternum (the internal mammary artery) and a vein from the leg (the saphenous vein, which runs along the inner leg from the groin to the ankle). Traditional harvesting of the saphenous vein requires a long incision down the entire leg to remove the blood vessel. This leaves patients with a scar that runs the full length of their leg. By contrast, endoscopic vein harvesting eliminates the need for such a large incision. With this less invasive technique, the surgeon removes the vein through one to three small incisions, each less than 1 inch in length, with the aid of a special video camera, or endoscope. The endoscope is a thin instrument with a tiny camera at the end that allows the surgeon to clearly view the removal of the segment of saphenous vein. Once the vein is removed, the incision(s) are closed. After surgery, other veins take over for the missing saphenous vein to maintain the health of the leg. The advantages of endoscopic vein harvesting go beyond avoiding a long leg scar. Patients undergoing EVH are also less likely to experience events that can prolong hospital stay or require re-admission for another surgery (e.g., wound complications, swelling, leg pain, infection). This is particularly true for patients at greater risk for leg wound complications, such as those with obesity, diabetes or peripheral vascular disease. Patients can therefore have a shorter recovery time and be back on their feet sooner than with traditional vein harvesting. Because of these advantages, more CABG procedures are being performed using endoscopic saphenous vein harvesting. Most people who require a bypass operation are candidates for EVH. Those who may not be candidates for EVH include patients who have pre-existing conditions (e.g., varicose veins, thrombophlebitis, peripheral venous disorders) or are too thin. In some cases, the surgeon may begin an EVH and then need to switch to traditional vein harvesting in mid-procedure.

EVH and alternative forms of bypass surgery

Besides traditional conorary artery bypass graft (CABG) surgery, there is a newer type of bypass surgery called off-pump bypass, or beating heart bypass surgery. Off-pump bypass allows the surgeon to sew the bypass graft into place without stopping the heart or using a heart-lung machine, both of which are required for traditional bypass. With “beating heart” revascularization, the movement of the heart is minimized using heart stabilizers and positioners. These devices keep the targeted regions of the heart virtually motionless while the physician performs the bypass. This off-pump method eliminates any risk of complications from use of the heart-lung machine (e.g., stroke, memory problems after surgery, or postpump syndrome). However, because most off-pump operations still use the traditional incision in the middle of the chest, patients may still require a longer recovery period than with less-invasive surgical approaches. Endoscopic vein harvesting (EVH) may also be used with a less-invasive form of conorary artery surgery known as minimally invasive direct coronary artery bypass, or MIDCAB. During a MIDCAB procedure, the physician gains access to the patient’s heart through a smaller incision in the side of the chest. This form of surgery is limited to patients with fewer blockages. It may be performed with or without the heart-lung machine.