Introduction:

Endoscopic vein harvesting (EVH) is a modern surgical technique used to obtain veins for coronary artery bypass grafting (CABG) procedures. This comprehensive article aims to provide a detailed understanding of EVH, including its benefits, procedure steps, patient selection, outcomes, and potential complications.

Benefits of Endoscopic Vein Harvesting:

EVH offers numerous advantages compared to traditional open vein harvesting:

• Minimally invasive: EVH utilizes small incisions and specialized endoscopic instruments, resulting in reduced tissue trauma and postoperative pain.
• Improved cosmetic outcomes: The small incisions used in EVH are cosmetically favorable, leading to less noticeable scars and improved patient satisfaction with their appearance.
• Faster recovery: Due to the reduced surgical trauma, EVH patients often experience shorter hospital stays, faster wound healing, and quicker return to daily activities.
• Decreased risk of wound complications: EVH has been associated with a lower incidence of wound infections, wound dehiscence, and wound-related complications compared to open vein harvesting.

Procedure Steps:

The EVH procedure typically involves the following key steps:

• Incision and access: Small incisions, usually in the leg, are made to access the target vein. Endoscopic instruments, including a camera and specialized dissecting tools, are inserted through these incisions.
• Visualization and dissection: The endoscope provides a magnified view of the vein, allowing the surgeon to carefully dissect and mobilize it while preserving surrounding tissues.
• Vein preparation: The harvested vein is prepared by dividing it into suitable segments based on the required graft length and ensuring optimal quality and viability.
• Extraction and closure: The vein segments are gently extracted through one of the incisions. The other incisions are closed with sutures or adhesive strips.
• Postoperative care: Following EVH, patients receive standard postoperative care, including wound management, pain control, and rehabilitation as needed.

Patient Selection:

EVH is suitable for a wide range of patients, including those with diabetes, obesity, peripheral vascular disease, and a history of prior vein stripping. However, individual patient factors and anatomy should be considered to determine the appropriateness of EVH in each case.

Outcomes and Potential Complications:

Studies have demonstrated comparable long-term graft patency rates between EVH and traditional open vein harvesting techniques. The overall clinical outcomes, including the reduction in angina symptoms and improved quality of life, are also similar. However, it is important to be aware of potential complications, such as wound infections, hematoma formation, wound dehiscence, nerve injury, and damage to the harvested vein.

Conclusion:

Endoscopic vein harvesting is a minimally invasive approach for obtaining veins in coronary artery bypass surgery. By understanding the benefits, procedure steps, patient selection criteria, outcomes, and potential complications associated with EVH, patients and healthcare professionals can make informed decisions and contribute to successful surgical outcomes.

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