Endoscopic Vein / 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 Vein 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 (EVH), 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. The quality of the vessel is checked prior to the surgery by both doppler ultrasound and by clinical means (Allen’s test). 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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