Medical knowledge, Patient Education
Endoscopic Saphenous Vein Harvesting
Endoscopic saphenous vein harvesting (ESVH) is a minimally invasive procedure to remove part of the saphenous vein in your leg. 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. The part of the vein that is removed during this procedure is used to make a path (bypass) around a blocked heart artery. ESVH is done as part of heart surgery called coronary artery bypass grafting (CABG). This is a surgery to bypassor to fix arteries of the heart (coronary arteries) that are narrow or blocked.
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:
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Any allergies you have.
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All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
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Any problems you or family members have had with anesthetic medicines.
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Any bleeding problems you have.
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Any surgeries you have had.
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Any medical conditions you have.
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Whether you are pregnant or may be pregnant.
What are the risks?
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Infection.
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Bleeding.
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Blood clot or gas bubble in the leg.
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Damage to nerves in the leg.
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Swelling of the leg.
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Collection of fluid under the skin (seroma).
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Opening of skin incisions (dehiscence).
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Death of skin tissue (necrosis).
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Heart attack.
What happens before the procedure?
Staying hydrated
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Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
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8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
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6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
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6 hours before the procedure – stop drinking milk or drinks that contain milk.
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2 hours before the procedure – stop drinking clear liquids.
Medicines
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Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
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Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
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Taking over-the-counter medicines, vitamins, herbs, and supplements.
General instructions
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You may have a physical exam and an ultrasound test to make sure the saphenous vein is healthy.
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Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
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Ask your health care provider:
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How your surgery site will be marked.
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What steps will be taken to help prevent infection. These may include:
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Removing hair at the surgery site.
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Washing skin with a germ-killing soap.
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Taking antibiotic medicine.
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What happens during the procedure?
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An IV will be inserted into one of your veins.
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You will be given one or more of the following:
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A medicine to help you relax (sedative).
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A medicine to make you fall asleep (general anesthetic).
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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.
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A flexible tube (catheter) may be put in your bladder to drain urine during and after the surgery.
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Your surgeon will make an incision just above or below the inside of your knee and will locate the saphenous vein.
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A blunt, hollow tube (trocar) will be inserted through the incision.
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Carbon dioxide will be pumped through the trocar to make a tunnel along the vein for the endoscope.
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The endoscope will be passed through the incision and up toward your groin.
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As the endoscope is passed along the vein, branches of the vein will be clipped and sealed with an electric current (electrocautery).
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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.
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The endoscope and the vein will be removed through your knee incision.
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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.
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After vein removal, the tunnel created for the endoscope will be flushed out.
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A tube will be put in place for blood and fluid to drain.
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The incisions will be closed with stitches (sutures).
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A compression dressing will be placed over the incisions.
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The part of the saphenous vein that was removed will be prepared for the heart bypass procedure.
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The rest of your heart surgery will continue.
The procedure may vary among health care providers and hospitals.
What happens after the procedure?
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Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
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Your drain and compression dressing will be removed.
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You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
Summary
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Endoscopic saphenous vein harvesting is a procedure to remove part of a vein in your leg so that it can be used to make a path (bypass) around a blocked artery in your heart.
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This procedure is done as a part of heart surgery.
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Follow instructions from your health care provider about taking medicines and about eating and drinking before the procedure.
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.
