Endoscopic vein harvesting (EVH) is a minimally invasive procedure performed to extract the saphenous vein from the leg – a blood vessel commonly chosen for a bypass graft. The procedure is part of coronary artery bypass graft (CABG) surgery, which is performed to bypass one or more blocked coronary arteries and restore oxygen-rich blood flow to the heart.

In CABG, a segment of blood vessel is harvested (taken from another part of the body) and used to create a detour around the blocked artery. The most commonly used conduits include an artery from behind the sternum (the internal mammary artery) and a vein from the leg (the saphenous vein, which runs along the inner leg from the groin to the ankle).

Traditional harvesting of the saphenous vein requires a long incision down the entire leg to remove the blood vessel. This leaves patients with a scar that runs the full length of their leg. By contrast, endoscopic vein harvesting eliminates the need for such a large incision.

With this less invasive technique, the surgeon removes the vein through one to three small incisions, each less than 1 inch in length, with the aid of a special video camera, or endoscope. The endoscope is a thin instrument with a tiny camera at the end that allows the surgeon to clearly view the removal of the segment of saphenous vein. Once the vein is removed, the incision(s) are closed. After surgery, other veins take over for the missing saphenous vein to maintain the health of the leg.

The advantages of endoscopic vein harvesting go beyond avoiding a long leg scar. Patients undergoing EVH are also less likely to experience events that can prolong hospital stay or require re-admission for another surgery (e.g., wound complications, swelling, leg pain, infection). This is particularly true for patients at greater risk for leg wound complications, such as those with obesity, diabetes or peripheral vascular disease. Patients can therefore have a shorter recovery time and be back on their feet sooner than with traditional vein harvesting.

Because of these advantages, more CABG procedures are being performed using endoscopic saphenous vein harvesting. Most people who require a bypass operation are candidates for EVH. Those who may not be candidates for EVH include patients who have pre-existing conditions (e.g., varicose veins, thrombophlebitis, peripheral venous disorders) or are too thin. In some cases, the surgeon may begin an EVH and then need to switch to traditional vein harvesting in mid-procedure.