Endoscopic Vessel Harvesting

What is Endoscopic Vessel Harvesting (EVH)?

Endoscopic Vessel Harvesting (EVH) is a minimally invasive technique used to harvest a vein graft for Coronary Artery Bypass Graft (CABG) Surgery. Since it is minimally invasive, the EVH procedure uses a small incision to obtain a bypass tube/graft for CABG. This is an improved technological advancement used as an alternative TO traditional graft harvesting methods.

Who requires Endoscopic Vessel Harvesting?

Patients suffering from Coronary heart disease whose coronary arteries cannot be amended using angioplasty are the rightful candidates for EVH. In most cases, blockages in the coronary artery are cleared by angioplasty and the patient recovers from the disease. However, in some cases, the blocked arteries are damaged permanently. And to keep the blood flowing properly, a bypass passage is provided by implanting a graft conduit harvested from the patient’s limbs.

Where is the graft/vein obtained from?

The graft conduit is usually harvested from the patient’s own arteries and veins located in his chest, leg, or arm. The great saphenous vein (GSV) is the most eligible graft for the EVH procedure. The GSV is the largest vein of the human body and it is located 2 cm anterior to the medial malleolus within the subcutaneous tissues of the leg, in the thigh. The GSV is capable of transporting the blood back to the heart against gravity.

What are the important considerations in successful Vessel Harvesting?

The success of CABG surgery may be influenced by the quality of the conduit used in grafting. It is of utmost importance that the vessel used in Coronary Artery Bypass Graft is handled well during the harvesting process and it is not damaged. To ensure a long-term patient result, the conduit quality should be good. The conduit may get damaged during the harvest due to the following reasons:

• Overhandling of the vessel during the procedure
• Storage conditions after harvest and before grafting
• The extent of thermal injury during branch division, cutting, and sealing
• Overdistension of the vessel

For long-term patient results and optimum performance the quality of the conduit must be maintained. It is therefore of the utmost necessity to avoid any unwanted thermal injuries, overhandling, and overdistension. The vessel must be stored properly after harvesting.

What are the advantages of EVH over conventional methods?

Conventional method: In this procedure, the skin of the leg is exposed for vein harvesting which involves making long incisions on the thigh. This kind of operation may traumatize the patient as the incision is particularly long and it may leave scar marks. Along with this, diabetic patients may develop wound complications and lead the patient to stay in the hospital for a longer period.

Endoscopic Vessel/vein Harvesting: To overcome health complications and other problems, EVH was introduced as an alternative. It is a minimally invasive technique. The advantages of EVH may be summarized as follows:

• Only small incisions measuring 1-2 cm are made to harvest the whole length of graft for CABG and the minimally invasive approach ensures less postoperative pain, no wound complications, and better acceptance by the patient.
• The usage of minimally invasive instruments to obtain the graft ensures the least damage to the vessel and its surrounding tissues.
• Comparatively smaller incisions ensure reduced blood loss and minimal dissection of the surrounding tissues of the leg.

What are the Key benefits of EVH?

EVH has the following benefits:

• Reduced risk of infection and wound complication
• Minimal scarring
• Faster recovery
• Less postoperative pain and swelling
• Reduced length of hospital stay
• Faster cardiac rehabilitation
• Reduced pain

With these benefits, it’s easier for the patient to get back to a normal and healthy life at a faster rate.
What are the risk factors for EVH?
Although Endoscopic vessel harvesting involves minimal complications however, the following are the risk factors for this procedure:

• Old Age: Patients older than 75 years have more chances of wound infection
• Smoking
• Diabetes
• Patients suffering from peripheral vascular disease

What kind of equipment is used for Endoscopic Vessel Harvesting?

The manufacturing companies provide a complete system of the devices used during the EVH. The system comprises the following:

• A Zero-Degree endoscope lens that is connected to a high-definition video display monitor through a cable.
• A light source attached to the lens to illuminate the area of operation.
• Carbon-di-oxide source – It is important as it insufflated and keeps the EVH tunnel open during the EVH procedure.
• A ready-made single-use kit that is used as a package to house the endoscope and electrocautery probe.

Team for performing EVH

We at Yashoda Hospital and Research Centre, Nehru Nagar, Ghaziabad, strive to create a safe and comfortable environment for patients. The team that performs the EVH at our hospital includes:

• Cardiovascular/Heart Transplant Surgeon(s): The doctor who performs heart-related surgeries.
• Surgical scrub nurse is a person who specializes in perioperative care, providing care to patients throughout the operation procedure.
• Surgical technician is a person who takes care of technical or equipment related problems.

Expert Doctors at Yashoda Hospital and Research Centre, Nehru Nagar Ghaziabad

Dr. Amit Rai is an expert cardiologist who holds experience worth over 34 years in clinical cardiology and medicine. He earned his MBBS in 1986 from Rani Durgavati Vishwavidyalaya, Jabalpur, Madhya Pradesh. And he holds M.D. awarded by Govt. Medical College, Jabalpur. Besides, he has also completed a fellowship in non-invasive cardiology from Navin C. Nanda National Institute of EchoCardiography and Cardiac Research, New Delhi.
Dr. Rai specializes in Diabetes, Medicine, and cardiology.

Dr. Ashok Sehgal is a dynamic and dedicated cardiologist who has an experience of more than 20 years in the medical field. He pursued his D.M. in cardiology from CMC Vellore. Dr. Sehgal specializes in all kinds of diagnostic peripheral vascular disease, cardiac catheterization, and angiographic studies on adults and children, rheumatic, coronary, and peripheral arterial disease. With more than 15 years of experience in cardiology, Dr. Sehgal performs over 150 angioplasties and over 500 diagnostic cardiac procedures annually.