Endoscopic Vessel Harvesting (EVH)

Many patients are surprised to learn that a bypass operation may actually include two surgical procedures.

• Primarily, the bypass surgery involves using a healthy blood vessel to “bypass” a damaged or blocked artery in the heart.
• The second procedure is the actual removal of a healthy blood vessel, typically the saphenous vein in the patient’s leg, which will be used to construct the bypass.

What is traditional vessel harvesting?

Traditional vessel harvesting procedures require a long incision or a series of incisions down the length of the patient’s leg, from the groin to the ankle. The greater saphenous vein is harvested intact through this large incision. The harvested vessel is then used as a graft that surgeons sew in place to bypass the blocked coronary artery.

What is Endoscopic Vessel Harvesting?

Recent advances in technology have made it possible to perform this second procedure in a new, less invasive way, called Endoscopic Vessel Harvesting, or EVH. Rather than make a large incision in the leg of a patient, surgeons can now make small incisions in the patient’s leg. Because this new procedure results in less muscle and tissue damage when harvesting the vein graft, this procedure may eliminate many of the complications associated with the former technique. This may offer significant benefits to you.

How is Endoscopic Vessel Harvesting Performed?

An endoscope, a special instrument used to view the inside of a hollow area, is connected to a video camera and inserted through a small incision in the leg. The endoscope is used to view the saphenous vein inside the leg and allows the surgeon to remove the vein with minimal stress to the leg.

What are the patient benefits from Endoscopic Vessel Harvesting?

This new procedure generally results in less muscle and tissue damage and therefore, may reduce the surgical trauma to the patient, reduced wound infections1², and decreases the incidence of wound healing complications^1,3,4. In other words:

• You should experience less tissue scarring
• Your leg wounds should be less painful⁵
• You should avoid an unsightly scar

You will be able to concentrate on your cardiac rehabilitation!

In most cases, the small incision approach can be used successfully. However, every surgical patient is unique, and your surgical team will recommend the best procedure for you. It is important to remember that the goal of any bypass surgery is to increase coronary artery blood flow. Increased blood flow may:

• Provide relief of angina (pain or tightness in the chest)
• Improve the pumping ability of the heart muscle
• Reduce the risk of heart attacks

Most importantly, the quality of your life should improve.

Clinical References

1. Bitondo JM & Dagett WM. Endoscopic vs. Open Saphenous Vein Harvest: A Comparison of Post-Operative Wound Complications. Annals of Thoracic Surgery, Feb 2002; 73(2):523-8.
2. Carpino PA, et al. Clinical benefits of endoscopic vein harvesting in patients with high risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery, Jan 2000; 119(1):69-76.
3. Crouch JD, et al. Open versus endoscopic saphenous vein harvesting: Wound complications and vein quality. Annals of Thoracic Surgery, Oct 1999; 68(4):1513-6.
4. Allen KB, et al. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surgery Forum 2000; 3(4):325-30.
5. Davis Z, et al. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. Journal of Thoracic and Cardiovascular Surgery, Aug 1998; 116(2):228-35.
6. Meyer M, et al. Histological evidence of the safety of endoscopic saphenous vein graft preparation. Annals of Thoracic Surgery, 2000; 70:487-91.