Nancy Chescheir, M.D.
Procedure eases vein harvesting
A new vein harvesting technique performed at Vanderbilt University Medical Center is making coronary artery bypass surgeries more appealing to patients by reducing pain and shortening recovery times.
Traditionally, the greater saphenous vein, located in the leg, is used as the conduit to bypass blocked coronary arteries and until recently, patients undergoing this type of heart surgery would require a lengthy incision along the inside of the leg to retrieve the vein.
Now, physicians have developed a less invasive technique — endoscopic vein harvesting — that typically requires only two small (2cm) incisions to remove the leg vein for use in the heart.
It's an improvement that patients will be happy to see.
James Greelish, M.D., assistant professor of Cardiac Surgery and one of the physicians supervising the new technique, said the traditional procedure of filleting the leg open for vein harvesting is problematic for several reasons, including increased infection rates, pain and poor aesthetic appeal.
“This new minimally invasive technique is of great benefit for our patients,” Greelish said. “There are many advantages — less pain, lower infection rates and improved mobility leading to quicker rehabilitation. It is exceedingly rare to see a patient return with a wound infection due to these smaller incisions. This in turn results in a cost savings to Vanderbilt.
“With less pain and improved cosmetics for our patients, it's a win-win situation for all. When you consider that two, 2-cm incisions now allow us to perform the same procedure that previously required an incision of the leg, the decision to implement this technology was an easy one to make.”
Vanderbilt is using the new Vasoview technology by Guidant Corp. to harvest veins. The steps of the procedure are as follows: an incision is made at the knee; a camera and dissector are inserted through a cannula (the device through which all the instruments are inserted into the leg) which is then inserted into the incision; another device called the trocar is also inserted, which allows for CO2 to be injected into the site and create a tunnel, or cavity, so that the medical team can manipulate the surgical instruments and remove the vein.
The vein harvesting is performed by registered nurse first assistants or by physician assistants under the supervision of physicians. Since beginning the new technique in September, Vanderbilt has performed 50 cases.
“At this time, there are two or three of us trained (to perform the EVH) and others are in line to learn,” said Rodney Heckman, R.N., first assistant in Cardiac Surgery at VUMC. “If patients can have a simple 2 cm incision at the knee and a small wound, approximately the size of a pencil, at the groin and toward the ankle, they will opt for it.
“The wounds heal quickly and the pain is greatly reduced. They get up and walk sooner and keep on going. Their overall recovery and health is impacted. Overall, this technique has changed the harvesting game tremendously.”
Although the learning curve for the new procedure has increased surgical times in the short term, Greelish expects the cardiac surgical teams to master the technique quickly. While in Boston at Brigham and Women's Hospital where Greelish and the newly appointed chair of Cardiac Surgery at Vanderbilt, John G. Byrne, M.D., trained and worked, the cardiac surgical team performed nearly 85 percent to 90 percent of the harvests using the endoscopic method.
“We expect to do the same or better here at Vanderbilt, and anticipate that 90 percent of all cases will be successful using the Vasoview technique within six months to a year,” Greelish said. “This will become the standard of care for harvesting veins for heart surgery. In summary, it is one of those situations where less is clearly more.”