Endoscopic Vein Harvesting
Endoscopic vein harvesting (EVH) is a minimally invasive procedure to remove the saphenous vein (which is used as a bypass graft) from the leg.
Saphenous Vein Removal
Normally, the surgeon makes a long incision from the ankle to the groin to remove the vein. However, endoscopic vein harvesting allows the vein to be removed with only 1 to 3 small, 1-inch incisions, resulting in less muscle and tissue damage than the standard procedure. This reduces the risk of complications of the leg wound, the need for blood transfusions during surgery, postoperative pain, and results in less scarring and a faster recovery.
Patients who have diabetes or peripheral vascular disease have a higher-than-average risk of leg wound complications, so these patients may particularly benefit from EVH. In most cases, this method can be used successfully, but in some patients the surgeon may decide that the traditional vein harvesting technique is more appropriate.
Does the vessel used to create the bypass graft make a difference?
The two vessels that are most commonly used to construct the bypass graft are the internal mammary artery (IMA) from inside the chest wall, and the saphenous vein (SVG) from the leg. Which one of these grafts is used in a particular patient depends on several factors, and affects the long-term outcome of the surgery. In the past, the saphenous vein was most commonly used, but it was later discovered that IMA grafts stay open longer, improve survival, and reduce the likelihood of future problems such as chest pain and heart attack. Because you have only two internal mammary arteries, if you have more than two blockages, both the IMA and SVG will be used. The SVG may also be used if the surgeon thinks your IMA is unsuitable for use as a graft; this could be because the IMA is blocked, too small to use, or is so delicate that removing it from the chest wall would damage the vessel.
Is an internal mammary artery (IMA) graft better than a saphenous vein graft (SVG)?
Both women and men have improved survival when at least one IMA graft is used, compared to patients who receive only SVGs. This is true in patients who have one, two, or three coronary arteries bypassed.23 Women who receive IMA grafts also spend on average 1 day less in the hospital than women who receive only SVGs.24 Although both women and men do better after surgery when they receive IMA grafts, in women the grafts are more likely to become blocked because women in general have smaller arteries than men.4
Are women less likely to receive IMA grafts?
Despite the fact that both women and men benefit from the use of IMA grafts, women who undergo bypass surgery are less likely to receive an IMA graft than men. In one large trial, 85% of men and only 72% of women received them.24 This difference could not be explained by factors such as age or other health problems.
Use of IMA grafts also varies greatly by hospital: one study reported that in some hospitals, only 54% of women received grafts, and in others 93% did.25 In some patients, the grafts may not be suitable for use in bypass surgery, but in most women the IMA is the graft vessel of choice.
