Endoscopic Radial Artery Harvesting

Endoscopic Radial Artery Harvesting: Standard of Care
ASHWINI M
EVH is an establised technique the world over.

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Patients recieving EVH in USA

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Pateints receiving EVH in Apollo, Bangalore

Endoscopic Radial Artery Harvesting

Coronary artery bypass graft surgery, or CABG is an established and life saving procedure. Its performed to bypass a blocked vessel in the heart and thus restores healthy blood flow to the heart. CABG or coronary artery bypass can be performed traditionally by cutting open the chest or minimally invasively termed MICS CABG or Keyhole bypass surgery or MICAS. Irrespective of how it’s performed the basic requirements remain the same.

This involves two primary steps

1. Healthy blood vessels are removed or harvested from the chest, leg, or arm. 

2. These are then used to bypass the blocked vessels.

The usual sites where the blood vessel is removed are

  • Internal mammary artery in the Chest
  • Long or Short Saphenous vein in the leg 
  • Radial Artery in the Forearm

The ‘bypass’ basically creates an alternative pathway for the blood to flow from the aorta to the Heart.

Open Vein Harvesting
“Endoscopic Vein Harvesting eliminates the long incisions, the associated risk of infection and pain. It allow’s patients to walk earlier without the discomfort of a long cut in the leg.”
Dr Sathyaki Nambala
ENDOSCOPIC VEIN HARVESTING — In Endoscopic Vein Harvesting  or EVH in short, the surgeon is able to remove the long saphenous vein or radial artery from a very small incision (approximately 2 cms). A specialized instrument called the endoscope (Hemopro 2 Vasoview) is used to isolate and remove the vessel under high definition videoscopic guidance. This is a very safe and reliable technique, provided the latest equipment is used by a skilled professional. The quality of the vein harvested is as good as that removed by the open technique.

ENDOSCOPIC RADIAL ARTERY HARVESTING — The radial artery, either from the left or right forearm is harvested using the endoscopic technique in suitable patients. It is therefore termed endoscopic radial artery harvesting. Unlike the open technique, which leaves behind a long ugly scar on the forearm, the endoscopic technique requires two small cuts that heal well with good cosmetic scars. The quality of the vessel harvested is comparable to the open technique. It’s important to understand that the radial artery may not be suitable to be used in all patients. Young patients are particularly likely to benefit from the radial artery being used as a conduit for bypass.

“The radial artery can be removed or harvested from the forearm either using the traditional open technique or the more advanced Endoscopic technique (EVH).”
The vessels that are removed are used to bypass blocked vessels of the heart. They provide an alternative route of blood flow to the heart muscle.
Bypass grafts

How do we know which of these is the better technique?

Open Vein Harvesting (Traditional Technique)

In this method the surgeon makes a long incision on your leg extending from the groin to the ankle for saphenous vein harvesting or arm  (extending from the wrist to the elbow for Radial Artery harvesting). This method has been in practice since the beginning of heart surgery. While being a safe and established technique it is primitive, crude and morbid.

  • This technique is also used as a back up when EVH fails in patients with very fatty legs or when the vein is diseased.

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MICS CABG (Multivessel) Part II

The Multi Vessel MICS CABG

Safe and effective,
upto 5 keyhole bypasses.

Yes, it’s the truth! We frequently meet patients who have been told “it’s impossible”. Here’s the evidence. Do we need to say more?

CT angiogram showing 5 functioning bypass grafts

Post MICS CABG, CT coronary angiogram showing all 5 bypass grafts functioning normally. 

Vessels grafted: LIMA to LAD, Radial Artery to Ramus Intermedius and OM, Vein grafts to PDA and PLV

Reliable Technique

Our technique is reliable and has been pioneered by us over half a decade. It’s what we do everyday.

Large experience

The worls’s largest experience in multivessel MICS CABG. We are truly proud of our achievements.

Evidence based

Several hundred patients have now undergone mulitple MICS bypasses. We have evidence to prove, it works!

CT angio Evidence

Still having doubts? Ask for a CT angiogram to prove the number of grafts you recieved. We are transparent.

Meet Mr NK…

Mr NK is 43 years old. He is married, has a brilliant career, eats healthy and exercises everyday. In short he is fit and has no problems. He was diagnosed with diabetes in his 20’s but has always controlled his blood sugar well. During a routine health check recently his ECG did not look normal. He was advised an angiogram and to his surprise showed four blocks in the blood vessels supplying his heart. He was advised a CABG. While this seems simple enough, it wasn’t.

 

Several questions ran through his mind. Who, Where, What options and What technique?

The NK’s took more than a month to look at all the options available. While enquiring about less invasive options to a conventional bypass they were told about  the MICS CABG performed by us in Bangalore. A family friend who had also undergone a similar procedure vouched for it. When other surgeons and doctors were asked about the MICS CABG they were told that he required 5 grafts and it was impossible to do it by the MICS technique.

They finally decided to find out for themselves, flew in to Bangalore and met me at Apollo. A week later he underwent successful MICS CABG with grafts to all the five blocked vessels. He did incredibly well and went home 4 days later. That’s not all. We did a CT angiogram for him which showed all 5 bypass grafts functioning well.

MICS CABG

Safe Reliable Outcomes.

Yes, the way we do a coronary bypass (CABG) has changed. Say ‘Good Bye’ to pain and prolonged recovery. And yes, practically everyone who needs a CABG is a candidate.

It’s painless

Significantly reduced pain compared to regular surgery.

It’s bloodless

Our blood usage has reduced by 70%. It’s as close to bloodless as possible.

Active faster.

Less disruptive to body tissue, non bone cutting allowing faster movement.

Zero infection

Infections are no longer a problem as they simply don’t happen. Even in diabetics!

Difficult for us to believe. Left the hospital on day 4, all 5 vessels bypassed and a CT angiogram with proof of work well done.

imageMr NK.

MICS CABG (Multivessel) Part I

MICS CABG (Multivessel) Part I

How many bypasses can be done by the MICS CABG technique?

This is a question that’s frequently asked by patients. Why does this question arise so frequently?

The vast majority of patients who are referred for bypass surgery (CABG) require two or more bypass grafts. The medical community is still not fully aware of the technique of MICS CABG and its wrongly believed that only a single graft can be done by MICS CABG. This is because most surgeons are still learning the technique and are capable of performing a single bypass. When these surgeons or physicians are consulted they incorrectly advise patients against undergoing an MICS CABG. This article was particularly written to educate and to simply to dispel this myth.

Are these patients given wrong information? In a way yes although it may be more from ignorance rather than on purpose. Many senior physicians are actually unaware and spend little time in updating themselves about current techniques. Less often we find that although the physicians knew, they actually discouraged patients from undergoing a less invasive procedure that was actually beneficial. The reasons for this are manifold. First incomplete knowledge breeds fear. Older physicians may be in touch with older surgeons who are unable to adapt to evolving techniques and therefore may condemn them from the fear of loosing clientele. Some may find it uncomfortable to call a younger colleague to enquire about a technique they are unaware of. Irrespective of the cause, it’s the patient who ends up suffering.

In part II of this article I will highlight our experience with MICS multi vessel bypass with actual patient details and scientific evidence towards the same.

Please leave a comment. If you or a member of your family has undergone a multi vessel MICS CABG, do write your story.

Part II of this post will carry a true patient experience. Its a must read!

Multi vessel MICS CABG is possible and performed on a daily basis

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Patients receiving 2 or more bypass grafts by MICS

Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

Endoscopic Vein Harvesting

Coronary artery bypass graft surgery, or CABG is an established and life saving procedure often performed to bypass a blocked vessel in the heart and thus restores healthy blood flow to the heart. This involves two primary steps

  1. Healthy blood vessels are removed or harvested from the chest, leg, or arm to be used in creating the vessel to be used as bypass or bypasses.
  2. The usual sites where the blood vessel is removed are
  • Internal mammary artery in the Chest
  • Long or Short Saphenous vein in the leg
  • Radial Artery in the Forearm

The bypass basically creates an alternative pathway for the blood to flow from the aorta to the Heart.

The vessels can be removed or harvested from the leg and forearm either using the Traditional Open Harvesting technique or the more advanced Endoscopic harvest (EVH) technique.

%

Patients recieving EVH in USA

%

Pateints receiving EVH in Apollo, Bangalore

Bypass grafts

How do we know which of these is the better technique?

Endoscopic Vein Harvesting (EVH)

With EVH, the surgeon is able to remove the long saphenous vein or the radial artery from a very small incision (Approximately 2 cms). He uses a specialized instrument called the endoscope to isolate and remove the vessel under high definition videoscopic guidance. This has been a very safe and reliable technique.

EVH is particularly recommended in those with diabetes, peripheral vascular disease, smokers, those with skin infection and in the obese. In general practically all patients in all age groups benefit from EVH. EVH does add a small additional cost to the operation on account of the disposable device used.

Open Vein Harvesting (Traditional Technique)

In this method the surgeon makes a long incision on your leg extending from the groin to the ankle for saphenous vein harvesting or arm  (extending from the wrist to the elbow for Radial Artery harvesting). This method has been in practice since the beginning of heart surgery. While being a safe and established technique it is primitive, crude and morbid.

  • This technique is also used as a back up when EVH fails in patients with very fatty legs or when the vein is diseased.

Angioplasty or Coronary Bypass Surgery (CABG): What every patient must know!

There is no one treatment guaranteed to be effective for all cases of coronary artery disease. But because there are different treatment options, it is important for every patient to have the information and resources necessary, after talking with a variety of healthcare professionals, to make informed decisions.

To determine the recommended form of treatment, physicians must first consider the extent of the problem. For those who have multivessel or left main coronary artery disease, surgery, not percutaneous intervention (PCI or Angioplasty) or stents, offers the best long-range outcome, according to David Taggart, MD, Professor of Cardiovascular Surgery at England’s University of Oxford.

Dr. Taggart, who has criticized the increasing trend to treat all patients with PCI or angioplasty without offering a surgical option, showed flaws in 15 trials of angioplasty versus surgery. Dr. Taggert believes that for the studies, low risk patients were used, whose outcomes would be excellent with any treatment.

Stent

“For these studies, 176,250 people were screened to find the ideal patients, and 95 percent of those screened were excluded,” Taggart said. “None of the patients in the trial had left main disease. Patients do want less invasive treatment, assuming the results are the same. But that is definitely not the case here.”

Dr. Taggart believes that part of the problem involves those who are responsible for decision making with patients. He said that when patients are informed of possible heart problems, their research should extend beyond a visit to a cardiologist.

“Failure to discuss CABG (coronary artery bypass grafting) means that the patient is often denied the best treatment option,” Taggert said. “Consent for PCI is often obtained inappropriately. Doctors are obligated to explain alternate options if they are more effective. Usually, the cardiologist is the gatekeeper, and there is a conflict of self-interest there, it is a self-referral. All patients with multivessel disease should be treated by a multidisciplinary team, including a surgeon.”

 

Heart with bypass grafts

Heart with bypass grafts

 

 

Taggert said that CABG is a remarkably safe and effective procedure, and has a good, long range prognosis.

Studies have also shed light on the merits of CABG over PCI under appropriate conditions. For example, a study published 2005 in the New England Journal of Medicine concluded that for patients with two or more diseased coronary arteries, CABG is associated with higher adjusted rates of long-term survival than stenting. That study showed that patients with three blocked arties who received stents were 56 percent more likely to die within three years as those who had bypass surgery. That study was addressed in a Wall Street Journal article which said that stenting, the popular, minimally invasive angioplasty procedure, carries a higher risk of death long term than does open heart bypass surgery as a treatment for blocked arteries. The Journal reported that more than a third of patients who received stents needed either surgery or additional angioplasties with stents within three years.

http://www.sts.org/patient-information/adult-cardiac-surgery/cabg-vs-stents-know-your-options

 

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