Name of the Procedure:

Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (CABG).

Summary

The procedure involves using a video-assisted endoscope to surgically harvest one or more veins, typically from the leg, to be used in coronary artery bypass grafting (CABG). This minimally invasive approach allows surgeons to view and remove the vein through small incisions.

Purpose

The procedure addresses coronary artery disease (CAD) by providing a healthy vein to bypass blocked arteries in the heart. The goal is to improve blood flow to the heart and relieve symptoms like chest pain and shortness of breath, thereby reducing the risk of heart attack.

Indications

• Severe coronary artery disease that cannot be managed with medication or less invasive procedures.
• Symptoms such as severe angina or shortness of breath.
• Patients with multiple blocked coronary arteries.
• Previous unsuccessful angioplasty or stenting.

Preparation

• Patients are usually asked to fast for 8-12 hours before the procedure.
• Medications may need to be adjusted or stopped.
• Preoperative blood tests, electrocardiogram (EKG), and imaging studies such as an echocardiogram or coronary angiography may be required.

Procedure Description

1. General anesthesia is administered.
2. Small incisions are made in the leg where the target vein is located.
3. A video-assisted endoscope is inserted through these incisions to visualize and dissect the vein.
4. The vein is carefully removed without the need for large incisions.
5. The harvested vein is then used to create a bypass around the blocked coronary artery.
6. Incisions are closed, and the patient is monitored for recovery.

Duration

The vein harvesting portion typically takes about 1-2 hours, while the entire CABG surgery may take 3-6 hours.

Setting

The procedure is performed in a hospital or surgical center equipped with specialized cardiovascular operating rooms.

Personnel

• Cardiothoracic Surgeon
• Surgical Assistant
• Anesthesiologist
• Scrub Nurse
• Circulating Nurse

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma
• Damage to surrounding tissues or nerves
• Deep vein thrombosis (DVT)
• Adverse reactions to anesthesia
• Rarely, complications related to the heart surgery itself such as arrhythmias or heart attack

Benefits

• Improved blood flow to the heart
• Relief from chest pain and other symptoms of coronary artery disease
• Potentially better long-term outcomes compared to traditional vein harvesting

Recovery

• Hospital stay of 5-7 days typically required.
• Pain management with medications.
• Encouraged to walk and perform breathing exercises to prevent complications.
• Restrictions on lifting and strenuous activity for several weeks.
• Follow-up appointments to monitor recovery and heart health.

Alternatives

• Medical management with medications and lifestyle changes.
• Percutaneous coronary intervention (angioplasty and stenting).
• Traditional open vein harvesting, which involves larger incisions.
• Pros and cons depend on individual patient factors and severity of disease.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Post-operatively, there may be some pain and discomfort at the incision sites, which can be managed with pain relievers. Gradual improvement in symptoms and overall well-being is expected within weeks to months.

Pain management includes medications and techniques to ensure comfort. Instructions for home care and signs of potential complications are provided before discharge.