Endoscopic Vein Harvesting
                     Endoscopic Vein 
Harvesting
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Overview
● Introduction
● Objectives
● Anatomy Review
● Traditional Open Vein Harvesting
● What is EVH?
● EVH Equipment
● Step-by-Step Procedure
● Advantages of EVH
● Disadvantages & Risks
● Clinical Outcomes
● Guidelines & Recommendations
● Conclusion
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Introduction
The greater saphenous vein (GSV), the most often utilized conduit in coronary 
artery bypass graft (CABG) surgery, has been harvested via endoscopic vein 
harvesting (EVH) for the past ten years. Because saphenous veins are long and 
easy to harvest, they are frequently used. The need for more and better conduits 
has grown as a result of the increased demand for CABG surgery worldwide and 
the growing number of patients who need multiple coronary artery bypasses in 
one procedure.
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Objectives Of EVH
● Understand the EVH procedure.
● Compare EVH with conventional open harvesting.
● Explore the benefits, risks, and clinical outcomes.
● Review current guidelines and best practices.
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Anatomy Review
● Great Saphenous Vein (GSV): longest vein in the body
● Located medially from ankle to groin
● Commonly used as a conduit in CABG
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Traditional Open Vein Harvesting
● Involves a long incision along the leg
● Associated with higher wound complications
● Increased patient discomfort and longer recovery
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What is EVH?
EVH stands for Endoscopic Vessel Harvesting, a minimally invasive surgical 
technique used to harvest veins from the legs for use as bypass grafts in coronary 
artery bypass grafting (CABG) surgery. It involves using a small incision and 
advanced camera system to remove the vein. 
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EVH Equipment
● Endoscope with camera
● CO₂ insufflation system
● Vessel dissector and clip applier
● Sealing or cautery device
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Step-by-Step Procedure
1. Small incision made near the ankle or knee
2. Insertion of endoscopic system
3. CO₂ insufflation to create working space
4. Dissection of vein from surrounding tissue
5. Side branches clipped or cauterized
6. Vein removed and flushed for use in CABG
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Advantages of EVH
● Reduced wound infection and pain
● Smaller scars and better cosmetic outcome
● Shorter hospital stay
● Faster recovery
● Improved patient satisfaction
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Disadvantages of EVH
● Learning curve for surgeons
● Potential for vein damage if improperly handled
● Equipment cost
● Risk of hematoma or residual CO₂
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Clinical Outcomes
● Studies show comparable graft patency rates to OVH
● Lower wound complication rates
● Equivalent or improved long-term outcomes
● Endorsed by major cardiac surgery guidelines
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Guidelines & Recommendations
● EVH is recommended in patients at high risk for wound complications (e.g., 
diabetes, obesity)
● Should be performed by trained personnel
● Emphasis on vein quality assessment before grafting
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Conclusion
Endoscopic Vein Harvesting (EVH) represents a significant advancement in 
coronary artery bypass surgery, offering a less invasive, patient-friendly alternative 
to traditional open harvesting. By minimizing surgical trauma, EVH reduces wound 
complications, pain, and recovery time, while maintaining comparable graft quality 
and long-term outcomes. 
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      Thank You
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