Endoscopic vein harvesting (EVH) is a minimally invasive procedure that patients may have rather than traditional vein harvesting when they undergo a coronary artery bypass graft (CABG).
The EVH procedure
A CABG increases blood flow in narrowed or blocked coronary arteries by attaching a healthy artery (obtained from elsewhere in the body, such as leg, chest or arm) to the part of the coronary artery which is blocked.
When a vein is removed from the leg (saphenous vein) for the purpose of a CABG procedure, it is traditionally taken out via a long cut (incision) made from the ankle to the groin. This can leave a visible scar on the leg.
Veins from the leg can be removed by EVH, which uses small cuts and minimally invasive equipment to take out the healthy blood vessel making as little damage to it or surrounding tissues. An endoscope (a long, thin, flexible tube with a camera) is inserted into a small incision above the knee and an image is then projected onto a monitor, allowing the surgeon to locate and remove the vein. After this, two smaller incisions (of around one centimetre) may be made near the groin and / or ankle to help removal.
As well as resulting in less scarring than traditional vein harvesting, studies have shown that EVH reduces the risk of infection or wound problems, causes less pain and swelling, and results in a shorter hospital stay, allowing patients to begin their cardiac rehabilitation programmes sooner.
EVH has been offered at Harefield Hospital since 2007 and Royal Brompton Hospital has been employing the technique since 2009. As it is a specialised service, not all patients undergoing CABG are offered it or may be suitable for the procedure. To discuss this further, please contact your consultant.
Between January 2007 and December 2014, Royal Brompton & Harefield NHS Foundation Trust performed 3,657 CABGs using EVH. The rate of leg wound infection for EVH was just 0.2% (nine out of 3,657) compared to 2.3% for traditional leg harvesting methods (96 out of 4,129).