KUALA LUMPUR: When someone undergoes coronary artery bypass graft (CABG) surgery, attention naturally centres on the heart. Yet the operation can also leave patients with a sizeable wound on the leg, where a vein is often taken to create the bypass.
Traditionally, removing that vein involves a long incision along the leg. Endoscopic vein harvesting (EVH) offers a less invasive alternative, using a small opening and a camera to guide the removal.
Consultant cardiothoracic surgeon Dr Zamrin Dimon said the technique can result in smaller scars, less pain, faster wound healing and a lower risk of complications, particularly for patients who may already have difficulty healing, such as those with diabetes.
CABG is recommended when several major coronary arteries are significantly narrowed or blocked, with the aim of improving blood flow to the heart.
“What we do is create a new vessel or conduit taken from another part of the body, such as the artery from the chest, the radial artery from the arm, or the saphenous vein from the leg," Zamrin explained.
The saphenous vein is commonly used because it is relatively long, large and lies close beneath the skin. Patients who need multiple bypasses may require more than one graft, with a single vein segment measuring around 18-20cm.
Under the conventional approach, known as open vein harvesting, removing that amount of vein can mean a wound almost as long as the vein itself.
“If we need 40cm of vein, the wound on the leg can be 40cm long. So, imagine having a large scar on your chest and then having another long scar on your leg," Zamrin said.
The issue is not only cosmetic: a large leg wound can become an added burden during recovery, especially if it heals slowly.
“Sometimes after five or six weeks, the wound is still open and wet, and patients will need frequent dressing - especially diabetic patients,” he added.
Pain and discomfort can also make patients less willing to move around soon after surgery, even though early mobilisation is important in reducing the risk of blood clots and other complications.
With EVH, the surgeon instead makes a small opening and inserts an endoscope, or tiny camera, to guide the removal of the vein from inside the leg. Most of the surrounding skin remains intact, leaving only a few small incisions, each around 4cm.
That difference can make recovery easier. Zamrin said the smaller wounds may heal within two to three days, allowing patients to start moving sooner and return more comfortably to daily activities.
EVH is not necessarily quicker, however. The technique can take about an hour or slightly longer, compared with around 45 minutes for conventional harvesting, particularly when a longer segment of vein is needed.
It also requires specialised training and surgical experience, which is one reason it is not yet used for every bypass operation.
Zamrin stressed that EVH is not intended to replace conventional vein harvesting in all cases; rather, it gives suitable patients another option to discuss with their surgeon.
Most patients can be considered for the technique, although those with varicose veins, very superficial veins or veins that are too thin may not be suitable.