Patients recieving EVH in USA
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.
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.
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.
- Small wound heals faster
- Allows early walking
- Reduced risk of infection
- Non scarring
- Less pain from more precise harvesting
- Greater patient satisfaction
- Painful as the incision is long and deep
- Wound takes a longer time to heal
- Higher chances of infection particularly in diabetics, women and the obese
- Pain from the leg will impair walking after surgery, will affect quality of life
- Scar runs along the entire length of leg
- Cosmetically poor in both men and women