About Endoscopic Vein Harvesting (EVH)

Endoscopic vein harvesting (EVH) is increasingly used to reduce the risk of infection and minimize pain during procedures. EVH is primarily performed during coronary artery bypass grafting (CABG) to harvest veins for bypass conduits, though it can also be used for other blood vessels like the radial and internal mammary arteries. The saphenous vein is commonly harvested for use in arteriovenous grafts for dialysis, peripheral vascular bypass procedures, and cerebral bypass surgeries.

EVH uses minimally invasive equipment to carefully remove the vein with minimal damage to surrounding tissues and the healthy blood vessel itself. The procedure involves internal visualization, side-branch cutting and sealing, and small incisions. EVH has several advantages, including a lower risk of infection and wound complications, reduced pain and swelling, and faster recovery compared to traditional methods.

A small blunt dissector or endoscopic camera is used to create a subcutaneous tissue tunnel under the skin, minimizing the size of incisions.

Procedure for Endoscopic Vein Harvesting (EVH)

EVH is a minimally invasive technique for removing healthy veins from the legs for use in bypass surgeries, such as coronary artery bypass grafting (CABG). Below are the general steps of the EVH procedure:

• Anesthesia: The patient is placed under anesthesia to ensure they are asleep and pain-free during the procedure.
• Incisions: The surgeon makes two or three small incisions near the knee and ankle on the leg.
• Endoscope Insertion: A flexible endoscope with a camera and light is inserted through one of the incisions and guided toward the vein
• Vein Harvesting: Specialized instruments are used to carefully remove the vein while the surgeon monitors the procedure on a screen.
• Closure: After the vein is harvested, the small incisions are closed with sutures or staples.
• Recovery: The patient is monitored in the hospital for several hours to ensure there are no complications such as bleeding. Medications may be provided to manage pain or discomfort and prevent infection.

Advantages of EVH:- Compared to traditional vein harvesting, which involves a long incision along the leg, EVH offers multiple benefits:

• Less pain and scarring
• Fewer complications
• Quicker recovery
• Better cosmetic results

However, not all patients are suitable candidates for EVH. The technique used will depend on factors such as the patient’s medical history, overall health, and the location and size of the veins. It’s important to discuss the risks and benefits of EVH with a healthcare provider to determine the best approach for each case.