Harvesting the Vein
During bypass surgery a surgeon
will use a healthy artery or vein to route the blood
supply around this blockage. These vessels are attached
to the heart and used as conduits or passageways for
the blood supply. The greater saphenous vein in your
leg is one choice for the surgeon. The Internal Mammary
Artery in the chest wall, and the Greater Saphenous
Vein in the leg are the most commonly used conduit.
Two Methods
The removal of the saphenous
vein is commonly referred to as "harvesting"
the vein. In the past the removal of all or a portion
of this superficial vein from the leg meant either
a long continuous incision, or multiple incisions
called "bridging" running from groin to
ankle.
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Traditional Vein Harvesting Technique
Long incision that can run the entire length of
the leg.
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Bridging Technique
Multiple, interrupted incisions running from groin
to ankle that maintain some of the skin integrity.
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In the past it was removed or "harvested"
by one of two techniques. A long, continuous incision
could be used or many small incisions with "bridging"
skin between them could be performed.
The Endoscopic Technique
Now it's possible, in most cases, to remove the saphenous
vein through one
or two small incisions. This is performed with special
instruments and
videoscopic techniques.
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The Endoscopic Option
The small incision is hardly noticed after it
heals. There is a reduction in incisions, pain,
swelling, infections and healing time. Nearly
all of our patients receive this procedure if
vein is required for the surgery. |
1.
During coronary artery bypass the surgeon will remove
the necessary amount of saphenous vein with the aid
of the endoscope and special videoscopic surgical
instruments. The endoscope allows the surgeons to
view the procedure on a television monitor in the
operating room. This visualization of the inner leg
gives the surgeon a clear path to follow during the
dissection and removal of the vein. The vein is removed
and then tested with a solution for its ability to
effectively carry the blood supply.
2. The
vein is then used by the surgeon as a "bypass"
or "graft" around the blockage or obstruction
in a coronary artery. The vein is connected from the
aorta to the coronary artery beyond the point of blockage.
3. Following
the bypass procedure the small incisions in one or
both legs are then closed with suture and protective
bandages.
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3 Days After
This gentleman is 3
days after his open heart surgery, the vein was
harvested endoscopically. Note the small incision
on his right leg. |
For the patient the endoscopic procedure means a faster,
more comfortable recovery and reduces the chances
of wound complications, compared to the traditional
open procedure.
Today, over 70% of all patients undergoing coronary
artery bypass surgery are candidates for endoscopic
vessel harvesting.
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