Name of the Procedure:

Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure

Summary

This procedure involves the removal of an artery from the upper extremity (such as the arm) to be used in coronary artery bypass graft (CABG) surgery, in which blood is redirected around blocked arteries in the heart. The harvested artery segment serves as a conduit to improve blood flow to the heart muscle.

Purpose

The primary purpose of this procedure is to provide a suitable artery for use in CABG surgery. The goal of the CABG surgery, supported by this procedure, is to restore adequate blood flow to the heart, alleviate symptoms of coronary artery disease such as chest pain, and reduce the risk of heart attacks.

Indications

• Severe coronary artery disease not amenable to other treatments
• Multiple blockages in the coronary arteries
• Symptoms like chest pain, shortness of breath, and fatigue not relieved by medications or lifestyle changes
• Poor response to less invasive procedures like angioplasty or stenting
• High risk of heart attack due to blocked arteries

Preparation

• Fasting 6-8 hours before the procedure
• Discontinuation or adjustment of certain medications, as instructed by the physician (e.g., blood thinners)
• Preoperative blood tests, electrocardiogram (ECG), and possibly a chest X-ray
• Cleaning and shaving of the area from which the artery will be harvested
• Signing informed consent after discussing risks and benefits

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgical site is sterilized, and an incision is made in the upper extremity (usually the arm).
3. The selected artery segment is carefully dissected and removed, taking care to preserve its integrity.
4. The incision is closed with sutures or staples and dressed appropriately.
5. The harvested artery is then used as a graft in the CABG surgery.

Tools and equipment:

• Scalpel and surgical scissors
• Forceps and retractors
• Sutures or staples
• Sterile dressings and bandages
• Hemostatic agents and irrigation solutions

Duration

The harvesting procedure typically takes about 1 to 2 hours, depending on the complexity and the specific artery being harvested.

Setting

The procedure is performed in a hospital operating room, usually as part of the overall CABG surgical procedure.

Personnel

• Cardiothoracic surgeon
• Surgical assistants and nurses
• Anesthesiologist for administering and managing anesthesia
• Operating room staff

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Nerve damage leading to numbness or weakness in the upper extremity
• Scarring
• Delayed wound healing
• Poor graft function or failure to achieve desired outcomes in CABG

Benefits

• Improved blood flow to the heart
• Relief from symptoms such as chest pain and shortness of breath
• Reduced risk of future heart attacks
• Overall improvement in quality of life and physical functioning

Recovery

• Monitoring in the hospital for a few days post-operation
• Pain management with medications
• Keeping the incision area clean and dry
• Gradual return to normal activities as advised by the doctor
• Follow-up appointments to monitor healing and graft function

Alternatives

• Usage of other vessels such as veins from the leg (saphenous vein) or other arteries like the internal mammary artery
• Percutaneous coronary interventions (angioplasty and stenting) if suitable
• Enhanced medical management with medications and lifestyle modifications

Patient Experience

During the procedure:

• The patient will be under general anesthesia, ensuring they are unconscious and pain-free. After the procedure:
• Expect some post-operative pain and discomfort at the incision site, managed with pain relievers.
• Swelling or bruising near the harvest site.
• Gradual improvement as healing progresses, with specific instructions provided to aid recovery and minimize complications.

Pain management and comfort measures include prescribed pain medications, keeping the arm elevated to reduce swelling, and applying cold compresses as guided by the healthcare team.