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

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