Endoscopic vein harvesting avoids risks linked to conventional technique in CABG

A coronary artery bypass graft (CABG) is typically used to treat coronary heart disease. It bypasses the blocked portion of the coronary artery with a piece of a healthy blood vessel from elsewhere in the body. These vessels are commonly taken from the leg or the wrist. [https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/]

However, harvesting the donor vessel requires a long surgical cut along the inside of the patient’s leg, eg, between their ankle and groin. Once the vessel is extracted, the surgeon then attaches one end of the vein above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle. Due to its invasive nature, conventional vein harvesting can cause infections and severe scarring on the leg. However, a minimally invasive procedure called endoscopic vein harvesting (EVH) can avoid these risks as it makes smaller cuts via minimally invasive equipment for vessel extraction.

Additionally, surgeons can limit the damage to the surrounding tissue causing less pain and swelling after the procedure, which reduces the total hospital stay. This also means the patient would be able to start cardiac rehabilitation programme sooner. MIMS Doctor spoke to Dr Kenny Cheng, a cardiothoracic surgeon from Mahkota Medical Centre (MMC) specializing in EVH, to learn more about the procedure.

Q. How is EVH different from regular vein harvesting, seeing that they both require the removal of a blood vessel from another part of the body and reattachment to the affected heart vessel?

A. Conventional leg vein harvesting for CABG requires a long wound from the ankle up to mid-thigh. EVH is a minimally invasive technique, which only requires a 2–3 cm incision for leg vein harvesting. EVH will definitely result in better cosmetic results, reduced pain, less infection or wound complication, and faster recovery.

Q: How long has this procedure been available or performed in the country?

A: EVH has been done in Malaysia for more than a decade but only limited to a few centres where the expertise is available. I initiated the EVH programme in MMC after I joined the hospital. I have been lucky that MMC is always supportive of new and cutting-edge technologies that doctors would like to introduce.

Q: How many cardiology centres are equipped to perform this procedure?
A: I am not too sure about the number of centres in Malaysia. However, at MMC, EVH has been the standard procedure as it allows for better patient outcomes. Furthermore, patients would not need to undergo invasive open surgery which leaves a scar.

Q: Should EVH be the gold standard moving forward?
EVH should be the gold standard as the benefits are tremendous. Hence, EVH is practiced where I work.

Q: Does EVH require any special training?
EVH requires special training as it uses specialized equipment. [The training period would differ from surgeon to surgeon.]