Getting coronary bypass patients back on their feet sooner

Often after coronary bypass graft surgery, patients suffer more pain in their leg than any other part of the body. The pain is due to the harvesting of a healthy blood vessel from the leg to construct the bypass graft. Traditionally, the vein was removed with a long incision that may stretch from ankle to groin. Many patients may not be aware there is an alternative.

Now, cardiovascular surgeons at Rush University Medical Center are able to remove the blood vessel through a small one-inch incision.

For patients like Edward Nytko, 62, of Barrington Hills, a smaller incision means a quicker recovery. Nytko was shocked to be up and walking just a few days after cardiac bypass surgery (CABG). Within a week he was back to working out on his treadmill. He experienced minimal post-operative pain and no complications due in a large part to endoscopic vessel harvesting (EVH).

"EVH has a tremendous potential benefit for patients by reducing leg wound complications and getting patients back on their feet faster," said Dr. Robert March, cardiovascular surgeon at Rush University Medical Center. "I also believe it helps the patient psychologically by avoiding the stigma of a large scar which can be a daily reminder of surgery."

With the EVH system, the clinician inserts a small camera through a one-inch incision to view the saphenous leg vein on a video monitor. The vessel is dissected from surrounding tissue and CO gas is infused to create a working tunnel. Tributaries are retracted, cauterized, and divided from the vessel. Once this is completed, the vessel is harvested intact and removed from the patient's leg. The harvested vessel is then used as a graft that the surgeon sews in place to bypass the blocked coronary artery.

The technology, manufactured by Guidant Corporation, is now also available to harvest the radial artery from the arm. Although only 20% of the CABG cases performed today utilize the radial artery, this percentage may grow with increases in the number of patients who require multi-vessel bypass surgery or additional bypass procedures. Blood pressure in radial arteries is higher than in veins, and as a result, arterial conduits may prove to be more durable grafts.

"One of our goals as surgeons is to improve the quality of our patient's lives," said Dr. Robert Higgins, chairman of the department of cardiovascular-thoracic surgery at Rush University Medical Center. "Since implementing the EVH technique for all patients undergoing CABG at Rush, the results have been quite remarkable for most patients."

Today, patient Ed Nytko is feeling excellent and is back to his normal routine visiting friends at his country club. His recent surgery has been a popular topic of conversation.

"After his bypass surgery, my friend complained of a lot of leg pain and is still self-conscious about the long scar on his leg," said Mr. Nytko. "After my surgery, the pain was negligible and I'm proud to show off my tiny scar."

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