Patient Care - Adult cardiac, endovascular, and thoracic aortic surgery
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Endoscopic vein harvesting - Some patients are surprised to learn that their bypass surgery will also involve an additional surgery to harvest a vein for transplant.
The saphenous vein, found on the inside of the leg, is usually the conduit of choice to bypass arterial blockages, to perform arterial bypass grafts and cardiac procedures. It normally does only about 10% of the work of circulating blood from the leg back to the heart. Therefore, it can be taken out without harming the patient or adversely affecting the leg. It is common for the leg from which the vein is taken to swell slightly during recovery from the surgery, but this is only temporary and treated with elevation of the leg.
In a traditional vein harvesting procedure, a standard long skin incision is usually performed to harvest the saphenous vein. This is the longest incision used in a standard surgical procedure, running from groin to ankle. Minor complications can result from this procedure.
An alternate method to harvest the saphenous vein is endoscopic vein harvesting - this involves use of an endoscope, a special instrument used to view the inside of a hollow area. The endoscope is inserted into small incisions in the leg, allowing the surgeon to remove the saphenous vein with minimal stress to the leg.
Patient benefits of endoscopic vein harvesting over the traditional long incision method include less scarring and, usually, less pain. Studies have shown that endoscopic vein harvesting allows for harvesting of long segments of vein, shorter and fewer incisions, and shorter surgical time.
Other arteries, veins used in bypass: The internal mammary artery (IMA) can also be used as the graft. This has the advantage of staying open for many more years than the vein grafts, but there are some situations in which it cannot be used.
The left IMA or LIMA is an artery that runs next to the sternum on the inside of the chest wall. It can be disconnected from the chest wall without imparing the blood supply to the chest. It is commonly connected to the artery on the heart that supplies most of the muscle, the left anterior descending artery or LAD.
Other arteries are also now being used in bypass surgery. The most common other artery used is the radial artery. This is one of the two arteries that supply the hand with blood. It can usually be removed from the arm without any impairment of blood supply to the hand.
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