Grafting

Obtaining a blood vessel for surgery

Before your surgeon can perform the bypass surgery procedure, he or she will first need to obtain a healthy blood vessel from another part of the your body.

The healthy blood vessel is used to bypass the blockage in the artery in your heart.

Obtaining a blood vessel actually requires a separate procedure that is performed immediately before your heart surgery. Depending upon the situation, one or more of the following vessels may be harvested, depending on how many vessels need to be bypassed:

grafting vessel harvesting

  • The internal mammary artery, which is in the chest
  • The greater saphenous vein, which runs the length of the leg
  • The radial artery, which runs from the elbow to the wrist in the arm

The greater saphenous vein is often used for CABG. Removing this vein does not have a negative effect on the circulation network of the leg, and most patients recover quite well.

Traditional harvesting of the greater saphenous vein

In the past, removing the greater saphenous vein meant that one long incision was made from the ankle to the groin depending on how many bypass grafts the surgeons needed to perform. This procedure often caused patients more pain than their chest incisions. Additionally, there is a greater risk of infection and the scar can make patients feel self-conscious long after they recovered.

Currently, the incision for the traditional harvesting of the great saphenous vein is the longest incision made in any surgical procedure—up to 50cm in length.

Bridging technique

Another procedure called bridging was also used, which enabled removal of the greater saphenous vein through several smaller incisions, each about three inches in length. This technique has complication risks such as infection, pain, and swelling. This procedure also puts a lot of tension on the vein and recent data suggests a bridged vessel may not perform well.

Endoscopic vessel harvesting

Today, there is another much less invasive option that usually requires only a small incision, about 2cm long. Endoscopic vessel harvesting, or EVH, can be used to remove the saphenous vein from the leg or the radial artery from the arm.

EVH uses special instruments to view and remove a blood vessel through a small incision. This results in much less trauma to the surrounding tissues of the leg or arm.

EVH not only causes much less pain and scarring, it also means that patients can recover more quickly, return to normal mobility, and begin their cardiac rehabilitation program sooner.

In several clinical studies, important benefits have been shown as a result of using endoscopic vessel harvesting, including:

  • Significantly less risk of infection and wound complications
  • Less postoperative pain and swelling
  • Faster recovery with minimal scarring
  • Greater patient satisfaction

Regardless of how the harvest procedure is performed, other blood vessels in the leg or arm remain in place.

EVH is the standard of care in the United States and is performed in most heart surgery hospitals. It is a good option for many patients. However, since each person is unique, you should discuss your choices with your doctor.