Were you scared when they said they would harvest a vein for heart bypass surgery? (Radial Artery & Saphenous Vein Harvesting)

You've probably heard a doctor tell a family member, friend, or acquaintance, "They need to do a heart bypass, and they'll take a vein from your arm or leg." At a time like that, it's normal to feel a little scared and curious. "Oh, what happens to that organ when they remove a vein from your arm or leg? Won't it bleed? Will there be a problem later?" You might be thinking things like that, right? Well, today I'm going to answer all those questions in a simple way that you can understand.

Simply put, what does it mean to remove a vein?

To understand this, let's first understand a little about what heart bypass surgery, or medically known as coronary artery bypass surgery, is.

Imagine that the main water pipe that brings water to your house is blocked somewhere. Now the water comes very slowly, or maybe not at all. What do you do then? Instead of cutting out the blocked part, you connect a new piece of pipe to the side and back of the blocked part and create a new path. Then the water will flow smoothly again.

Heart bypass surgery is exactly like this. When things like cholesterol build up in the coronary arteries that supply blood to our heart and become blocked, the heart does not get the amount of blood it needs. That's when things like angina occur. What doctors do is, they use a healthy blood vessel (vein) taken from another part of your own body to create a new path around and around the blocked area. This new path is called a graft .

So, this 'removing a vein', or 'harvesting' as doctors call it, refers to the process of taking the healthy blood vessel needed to build that new road from somewhere else in your own body.

Where do these veins usually come from?

There are two types of blood vessels most commonly used for this bypass surgery.

1. Radial Artery

This is on your forearm, from your elbow to your wrist. Do you remember where a doctor would feel your pulse when they felt it? That's where the radial artery comes from. We have two main arteries in our arms. This is one of them.

2. Saphenous Vein

This is the longest vein in our body. It starts on the inside of the foot, then goes up through the groin and joins a deep vein in the thigh. The function of veins is to carry oxygen-depleted blood back to the heart. Since this saphenous vein is located just below the skin of the leg, it is very easy to remove surgically.

How does the doctor decide which vein to use?

This is not a decision to be made overnight. Your medical team will make this decision after carefully examining your condition and considering several factors. They will ask you to undergo several tests before the surgery.

• Complete Blood Count
• Chest X-ray
• Imaging tests such as CT Scan or MRI
• Angiogram test - This is used to check exactly how blocked the arteries are in the heart.

The final decision is made after considering the results of these tests, as well as the factors in the table below.

Typically, doctors will try to get the vein from your nondominant side . That means, if you are right-handed, they will try to get the radial artery from your left hand.

What actually happens during surgery?

This vein removal procedure takes place right before your bypass surgery. You are completely anesthetized (general anesthesia) and this is all done. So you won't feel any pain.

There are two main methods for removing the vein.

1. Endoscopic Surgery:This is the most commonly used minimally invasive procedure. In this procedure, a thin tube called an endoscope is inserted through one or two very small incisions in the skin of the arm or leg. At the end of this tube is a camera, a light, and delicate instruments needed for the operation. The surgeon, watching on a monitor, carefully separates the vein from the surrounding tissue and removes it.

2. Open Surgery: In this method, the skin is cut lengthwise where the vein is located and the vein is removed so that it is directly visible. This method was used in the past, but is now less used due to the endoscopic method.

Once the artery is removed, the main part of the bypass surgery begins. The surgeon attaches one end of the graft to your aorta and the other end to the blocked artery. Now you have a new, healthy path for blood to flow to your heart.

What are the advantages and risks of this method?

As with any medical procedure, there are benefits and risks. The benefits of the endoscopic procedure in particular are many.

Things to consider during recovery after going home

Your main focus should be on recovering from bypass surgery. After you leave the hospital, it is very important to follow the instructions given by your doctor and nursing staff exactly .

• Taking the right medications: Take the medications you are given to prevent blood clots (anticoagulants) and painkillers at the right time and in the right dosage.
• Keeping wounds clean: You will be taught at the hospital how to clean and dress your cuts. Follow these instructions.
• Avoid lifting weights: Do not lift any weights until your doctor tells you to.
• Wearing special socks:If you have had your saphenous vein removed from your leg, you will be asked to wear special compression stockings to reduce swelling. You will also be advised to keep your leg slightly elevated.

When should you seek immediate medical advice?

In addition, if one or more of the following symptoms appear, inform your doctor without delay.

• Chest pain or tightness (Angina)
• Sudden excessive sweating
• Difficulty breathing (Dyspnea)
• Signs of infection, such as yellow discharge from surgical sites and fever

Bypass surgery is a very important life-saving surgery. Taking a vein from your own body is an essential part of it. With the advancement of technology, this procedure can now be done very safely, with minimal pain and a quick recovery. So don't be unnecessarily afraid of it. If you have any problems or doubts, talk to your doctor openly about it.