Endoscopic Vessel Harvesting

About Coronary Artery Bypass Surgery

Coronary artery bypass grafting is a surgery to treat coronary artery disease. The surgery reroutes blood around blocked arteries to improve blood flow and oxygen to the heart. The procedure involves taking, or harvesting, a vein or artery from another part of the body, typically the leg, and sewing or grafting the vessel to the coronary artery to bypass the clogged artery and restore blood flow.

Obtaining the Healthy Vein or Artery

Traditionally, the vessel is removed from the leg through a long incision that may stretch from ankle to groin. In addition to a long, visible scar, some patients who have the traditional method of vessel removal experience more postoperative pain from the leg incision than from the chest incision. Rehabilitation may also be delayed because the leg incision may make it more difficult for the patient to stand or walk after surgery.

Endoscopic vessel harvesting (EVH) offers patients a minimally-invasive alternative for obtaining the vein or artery. Using Boston Scientific’s VasoView® System, the vessel can be removed through one to three smaller incisions, each approximately one inch in length. During the procedure, an endoscope is connected to a video camera and inserted into the incision, providing the surgeon with the view needed to find the vessel. Next, using carbon dioxide, the surgeon creates a working tunnel in order to remove the vessel with minimal stress to the leg. This procedure is designed to reduce the surgical trauma to the patient and decrease the incidence of wound healing complications.

An estimated 282,000 coronary artery bypass surgeries were performed in the U.S. in 2005. In the same year, about 80% of EVH procedures in the U.S. were performed using the VasoView® System. Over 600,000 VasoView® cases have been performed worldwide to date.

Benefits of Endoscopic Vessel Harvesting

EVH eliminates the long incision required to remove the vessel used in coronary artery bypass surgery. This may reduce postoperative pain, recovery time, infection rates and scarring, allowing patients to walk sooner and more easily.

Below is a scarring comparison between a patient who underwent EVH (left) compared to a patient who underwent the traditional open method.

Endoscopic Vessel Harvesting
Clinical data has shown that patients treated with EVH experienced significantly fewer wound complications and infections, as well as reduced pain in the leg.1-4 Clinical data has also shown the quality of an endoscopically harvested vein is similar to a conventionally harvested vein.5

About Boston Scientific’s VasoView EVH System

Boston Scientific’s VasoView® System is an intuitive, all-in-one EVH system designed to minimize the scarring and risk of infection associated with traditional harvesting procedures. The first generation VasoView® System was cleared for market in 1995. The latest generation products, VasoView® 7 and VasoView® HemoPro, were launched nationwide May 1st, 2006. Together with VasoView® 4 and VasoView® 6, the company offers a complete portfolio of products for new and experienced harvesters alike.

All VasoView® products are indicated for harvesting both the saphenous vein in the leg and the radial artery in the arm for use in coronary bypass surgery. The radial artery is currently harvested in approximately 20% percent of bypass procedures each year. This percentage may grow with increases in the number of patients who require multi-vessel bypass surgery or additional bypass procedures.

References

  1. Bitondo JM & Dagett WM. Endoscopic vs. Open Saphenous Vein Harvest: A Comparison of Post-Operative Wound Complications. Annals of Thoracic Surgery, Feb 2002; 73(2):523-8.
  2. Carpino PA, et al. Clinical benefits of endoscopic vein harvesting in patients with high risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery, Jan 2000; 119(1):69-76.
  3. Crouch JD, et al. Open versus endoscopic saphenous vein harvesting: Wound complications and vein quality. Annals of Thoracic Surgery, Oct 1999; 68(4):1513-6.
  4. Davis Z, et al. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. Journal of Thoracic and Cardiovascular Surgery, Aug 1998; 116(2):228-35.
  5. Meyer M, et al. Histological evidence of the safety of endoscopic saphenous vein graft preparation. Annals of Thoracic Surgery, 2000; 70:487-91.
  6. Acar et al, J Thorac Cardiovasc Surg 1998;116:981-9
  7. Tatoulis et al, Ann Thorac Surg 2002;73:143-8