KUALA LUMPUR, Sept 29 — When patients undergo coronary artery bypass graft (CABG) surgery, the focus is naturally on treating blocked arteries in the heart, but the procedure can also leave them with a sizeable wound on the leg where a vein is traditionally harvested for the bypass.
While conventional vein harvesting involves making a long incision along the leg, patients now have another option in the form of endoscopic vein harvesting (EVH), a minimally invasive technique that uses a small incision and a camera to remove the vein.
Sunway Medical Centre Velocity (SMCV) Consultant Cardiothoracic Surgeon Dr Mohd Zamrin Dimon said the technique could offer patients small scars, less pain, faster wound healing and a lower risk of wound complications.
He said EVH was particularly beneficial for patients who may have difficulty with wound healing, including those with diabetes.
According to Dr Mohd Zamrin, when several major coronary arteries are significantly blocked, CABG may be recommended to improve blood flow and reduce the risk of a heart attack.
“CABG is a heart bypass surgery, performed to create a new pathway for blood to flow when the coronary arteries supplying the heart become narrowed or blocked.
“What we do is we 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,” he said in an exclusive interview with Bernama at Sunway Medical Centre Velocity here recently.
Dr Mohd Zamrin said the saphenous vein was commonly used because it is relatively long, large and located superficially beneath the skin. He said patients requiring multiple bypasses could need more than one vein graft, where a single vein segment could measure around 18 to 20 centimetres (cm).
“Under the conventional approach, which we call open vein harvesting (OVH), removing that length of vein requires a long incision along the leg. 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,” he said.
Aside from the scarring, Dr Mohd Zamrin said large leg wound could present an additional recovery challenge after CABG, with some patients undergoing OVH having wounds that remained wet or open for several weeks after surgery and requiring continued dressing.
“Sometimes after five or six weeks, the wound is still wet, still open and patients will need frequent dressing, especially diabetic patients,” he said.
He added that a large wound could also make movement more difficult and uncomfortable for patients during recovery, potentially discouraging early mobilisation, which is important in reducing the risk of blood clots and other complications, including stroke.
Instead of making one long incision, Dr Mohd Zamrin said EVH involves only a small opening through which the surgeon inserts an endoscope, or a tiny camera, to guide the removal of the vein along the leg.
The surrounding skin remains largely intact, leaving patients with only up to three small incisions, each measuring about 4cm.
Adding to that, Dr Mohd Zamrin said the difference in recovery could also be significant, with the small incisions potentially healing within two to three days, allowing patients to start moving shortly after surgery and return to their daily activities.
Despite the potential benefits, he estimated that fewer CABG procedures currently use EVH, with the need for specialised skills and training among the reasons for its limited adoption.
He said EVH also took longer to perform than conventional vein harvesting, with the endoscopic procedure taking about an hour or slightly longer compared with around 45 minutes for the traditional method, particularly when a longer section of vein was needed.
He said the issue is not about completely replacing conventional vein harvesting, but ensuring patients know that another option exists.
However, he stressed that the final decision should be based on proper medical assessment and discussion with the attending surgeon, noting that while most patients are suitable for EVH, those with varicose veins, very superficial veins or veins that are too thin may not be suitable for the endoscopic vein harvesting approach.
