Endoscopic Saphenous Vein Harvesting

A procedure called saphenous vein harvesting is done as part of some heart surgeries. Blood vessels that carry blood to the heart can become blocked. When that happens, a surgeon can create a detour (bypass) around the blocked area. To do this, the surgeon uses a healthy blood vessel from someplace else in your body. The vein that runs along the inside of your leg (greater saphenous vein) is often used. It goes from your ankle to your groin. Saphenous vein harvesting is the procedure that is done to take part of this vein from your leg. For an endoscopic procedure, only very small cuts (incisions) are needed. The surgeon uses a tiny tool (endoscope) to find and take out part of the vein.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Problems with your leg veins, such as painful or enlarged (varicose) veins.

  • Other health problems, including diabetes, history of wound problems, and kidney problems.

  • Possibility of pregnancy, if this applies.

RISKS AND COMPLICATIONS

Saphenous vein harvesting is done as a part of heart surgery. The heart surgery may have risks. However, there are usually few problems with the vein harvesting part of surgery. This is especially true with an endoscopic procedure. However, problems can occur, such as:

  • Bleeding in the leg.

  • Bleeding under the skin.

  • Infection.

  • Leg pain.

  • Leg swelling.

  • Nerve damage.

Some people are more likely than others to have problems with saphenous vein harvesting. They include:

  • Women.

  • People with diabetes.

  • People who are overweight.

  • People who smoke.

  • People who have had a blood vessel disease in their legs.

  • People who have varicose leg veins.

BEFORE THE PROCEDURE

  • A medical evaluation will be done. This may include an ultrasound exam to make sure your saphenous vein is healthy.

  • If you smoke, quit a few weeks before your surgery.

  • A week before the procedure, stop taking drugs that can cause bleeding during and after your surgery. This includes aspirin, nonsteroidal anti-inflammatory drugs, ibuprofen, and naproxen. Also stop taking vitamin E.

  • If you take blood thinners, ask your surgeon when you should stop taking them before surgery.

  • The day before the surgery, eat only a light dinner. Do not eat or drink anything after midnight. Ask your caregiver if it is okay to take any needed medicines with a sip of water.

  • Arrive at least 1 hour before the surgery, or as directed by your surgeon.

PROCEDURE

Saphenous vein harvesting will be done at the very beginning of your heart surgery. It is usually done while your heart surgery is being started.

  • Small monitors will be put on your body. They are used to check your heart, blood pressure, and oxygen level.

  • You will be given an intravenous line (IV). A needle will be put in your arm or hand. It is hooked to a plastic tube. Medicine will flow directly into your body through the IV.

  • You will be given medicine that makes you sleep (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 leg will be cleaned with a germ-killing (antiseptic) solution.

  • When you are asleep, 1 to 3 incisions will be made on the inside of your leg. The endoscope will be put into these incisions. The endoscope is a long, thin tube with a tiny camera on the end. The surgeon will use this tool to find a segment of vein that will work for the bypass. This segment is cut out.

  • Clips, ties, or electric current (cautery) may be used to seal off the vein. These methods stop the bleeding. Other veins will take over for the one that is removed to keep your leg healthy. 

  • The surgeon will close the incisions. Clips or small stitches (sutures) may be used.

  • A drain may be placed under the skin of your leg. It looks like a long, thin tube, and it allows fluids to drain out of your leg after the surgery.

  • Your leg will probably be wrapped in an elastic bandage or stocking.

  • The vein that was harvested will be used in your heart surgery.

AFTER THE PROCEDURE

  • When your heart surgery is over, you will probably be taken directly to the intensive care unit (ICU). You will continue to use a breathing machine (ventilator) and get fluids through the IV for a while.

  • When no more fluid drains from your leg, the drain in your leg will be taken out.

  • You will be able to go home once you are recovered from your heart surgery. Most people stay in the hospital for at least 4 days. You may spend 1 to several days in an intensive care area. Then you may spend several days in a regular hospital room.