What is Endoscopic Saphenous Vein Harvesting (EVH)
Endoscopic saphenous vein harvesting is a procedure to remove part of the saphenous vein in your leg. The saphenous vein is also called the great saphenous vein or the long saphenous vein.
This vein runs from the inside of your ankle, up along the inside of your knee, and up to your groin. It returns blood from your leg to your heart. This part of the vein that is removed during the procedure is used to make a detour (bypass) around a blocked heart artery. EVH is done as part of heart surgery.
Endoscopic surgery is surgery done using a thin telescope (endoscope) with a camera. The endoscope is inserted through a small incision.
Tell a health care provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any problems you or family members have had with anesthetic medicines.
- Any blood disorders you have.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Infection.
- Bleeding.
- Blood clot or gas bubble forming in the leg.
- Damage to nerves in the leg.
- Swelling of the leg.
- Collection of fluid under the skin (seroma).
- Opening of skin incisions (dehiscence).
- Death of skin tissue (necrosis).
- Heart attack.
What happens before the procedure?
Follow instructions from your health care provider about eating or drinking restrictions.
- You may have an ultrasound exam to make your sure the saphenous vein is healthy.
- Ask
your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
- Plan to have someone take you home after the procedure.
- If you go home right after the procedure, plan to have someone with you for 24 hours.
- Do notuse tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
- Ask your health care provider how your surgical site will be marked or identified.
- You may be given antibiotic medicine to help prevent infection.
What happens during the procedure?
EVH will be done at the very beginning of your heart surgery. It is usually done while your heart surgery is being started.
- To
reduce your risk of infection:
- Your health care team will wash or sanitize their hands.
- Your skin will be washed with soap.
- Small monitors will be put on your body. They will be used to check your heart rate, blood pressure, and oxygen level.
- An IV tube will be inserted into one of your veins.
- You
will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to make you fall asleep (general anesthetic).
- A tube will be put in your throat to help you breathe during the surgery. It will also be used to give you anesthetic medicine during the surgery.
- A soft tube (catheter) may be put in your bladder to drain urine during and after the surgery.
- Your surgeon will make a cut (incision) just above or below the inside of your knee and will locate the saphenous vein.
- A blunt, hollow tube (trocar) will be inserted through the incision.
- Carbon dioxide will be pumped through the trocar to make a tunnel along the vein for the endoscope.
- The endoscope will be passed through the incision and up toward your groin.
- As the endoscope is passed along the vein, branches of the vein will be clipped and sealed with an electric current (electrocautery).
- A second small incision will be made in your groin. The upper part of the vein will be found through this incision. It will be divided and tied off.
- The endoscope and the vein will be removed through your knee incision.
- If more vein is needed, the same procedure will be done in your lower leg. The endoscope will be passed through your knee incision down toward your ankle. An incision will be made near the inside of your ankle to find the vein, divide it, and tie it off.
- After vein removal, the tunnel created for the endoscope will be flushed out.
- A tube will be put in place for blood and fluid to drain.
- The incisions will be closed with stitches (sutures).
- Your leg will be wrapped with a type of bandage that supports the veins and helps them pump blood (compression dressing).
- The part of the saphenous vein that was removed will be prepared for the heart bypass procedure.
- The rest of your heart surgery will continue.
The procedure may vary among health care providers and hospitals.
What happens after the procedure?
- Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
- You may be given elastic stockings to wear.
- Your drain and compression dressing will be removed.
Endoscopic Saphenous Vein Harvesting, Care After
Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.
What can I expect after the procedure?
After the procedure, it is common to have:
- Pain.
- Bruising.
- Swelling.
- Numbness.
Follow these instructions at home:
Medicine
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Do notdrive or operate heavy machinery while taking prescription pain medicine.
Incision care
- Follow
instructions from your health care provider about how to take care of the
cut made during surgery (incision). Make sure you:
- Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
- Change your dressing as told by your health care provider.
- Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
- Check
your incision area every day for signs of infection. Check for:
- More redness, swelling, or pain.
- More fluid or blood.
- Warmth.
- Pus or a bad smell.
General instructions
- Raise (elevate) your legs above the level of your heart while you are sitting or lying down.
- Do any exercises your health care providers have given you. These may include deep breathing, coughing, and walking exercises.
- Do notshower, take baths, swim, or use a hot tub unless told by your health care provider.
- Wear your elastic stocking if told by your health care provider.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- Medicine does not help your pain.
- Your pain gets worse.
- You have new leg bruises or your leg bruises get bigger.
- You have a fever.
- Your leg feels numb.
- You have more redness, swelling, or pain around your incision.
- You have more fluid or blood coming from your incision.
- Your incision feels warm to the touch.
- You have pus or a bad smell coming from your incision.
Get help right away if:
- Your pain is severe.
- You develop pain, tenderness, warmth, redness, or swelling in any part of your leg.
- You have chest pain.
- You have trouble breathing.
