Minimally invasive video-assisted endoscopic vein harvesting (EVH) in peripheral bypass procedures

Saphenous vein harvesting remains a 20% source of morbidity in patients who require lower extremity bypass or coronary artery bypass grafting. In an attempt to reduce the complications associated with this procedure, minimally invasive video-assisted vein harvesting is propagated. The technique uses currently available endoscopic equipment with mechanical retraction to dissect the great saphenous vein with two limited incisions. The dissection is visualized on the video monitor to isolate and control side branches by clips. The vein is removed for reverse arterial bypass grafting or dissection is completed for an in situ bypass procedure. Initial experience with ten patients undergoing peripheral bypass procedures showed a mean vein-preparation time of 60 min. Two of seven in situ bypass procedures were complicated by side branch damage controlled through longer skin incision. After a mean follow-up of 12 months, all bypasses are patent. Taking our own experience as well as that reported in the literature into consideration, aspects of cost-effectiveness are discussed.