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Vein Excision

(Vein Harvest)

Definition

Veins can sometimes be used to replace arteries that are diseased. The process of removing them is called harvesting.
Leg veins are frequently used for vein harvesting. For open chest procedures, like coronary artery bypass grafting (CABG), veins or other blood vessels in the chest are often used.

Reasons for Procedure

Diseased arteries with atherosclerosis have a buildup of plaque that can block the flow of blood. Coronary (heart) or carotid arteries to the brain are often repaired by making a bypass. Vein grafts are most often used to bypass these blocked arteries.
Coronary Artery Bypass Grafts
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Possible Complications

Complications are rare, but no procedure is completely free of risk. There may include:
  • Bleeding
  • Damage to nerves
  • Infection at the vein harvesting site
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

The preparation you will need will be determined by the primary procedure. In most cases, it will be a major cardiac or vascular surgery for which you will be hospitalized and evaluated thoroughly.
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Statins or cholesterol medicine
  • Certain medicines for diabetes
You will not be able to eat or drink for 8 hours prior to the procedure.

Anesthesia

You will be given general anesthesia. It will make you sleep.

Description of Procedure

Traditional Technique
A long cut in the skin will be made to expose the entire length of the vein. Every branch of the vein will be found and tied off. The vein will be removed. The skin will be closed with stitches or staples.
Endoscopic Technique
Two small incisions are made at either end of the vein. A special long, thin tool with a camera on the end (endoscope) is passed through one of the incisions and along the vein. The tool will separate the vein from its branches and surrounding tissue. The vein will then be removed through the second incision at the other end of the vein.
Two small incisions are made at either end of the vein. A special long, thin tool with a camera on the end (endoscope) is passed through one of the incisions and along the vein. The tool will separate the vein from its branches and surrounding tissue. The vein will then be removed through the second incision at the other end of the vein.

Immediately After the Harvesting

The primary surgery will take place. Your leg (or legs) will be wrapped tightly to prevent bleeding from the remaining veins.

How Long Will It Take?

Vein harvesting is usually done at the same time as the primary procedure. It does not add time to the total surgery.

How Much Will It Hurt?

Leg pain from the long incision method may be significant. Talk to your doctor about a plan to manage pain.

Average Hospital Stay

Your hospital stay will depend on your primary procedure. Vein excision will not extend your stay.

Postoperative Care

During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medicines you have been given
  • Any changes of color in your leg, or if your leg becomes cold, numb, or tingly
  • Cough, shortness of breath, or chest pain
  • Dizziness or weakness
  • Calves that are red, swollen, or warm to the touch
In case of an emergency, call for medical help right away.

RESOURCES

Cardiothoracic Surgery, University of Southern California http://www.cts.usc.edu

The Cardiothoracic Surgery Network http://www.ctsnet.org

CANADIAN RESOURCES

Mount Sinai Hospital, Canada http://www.mtsinai.on.ca

University of Ottawa Heart Institute http://www.ottawaheart.ca

References

Bitondo JM, Daggett WM, et al. Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications. Ann Thorac Surg. 2002 Feb;73:523-528.

Mid-Atlantic Surgical Associates website. Available at: http://www.heartsurgeons.com. Accessed September 1, 2005.

Mini invasive technique for saphenous vein harvesting. Laparoscopy.com website. Available at: http://www.laparoscopy.com/pictures/vaso.html. Accessed September 1, 2005.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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