GSV Harvest

Great Saphenous Vein (GSV) Harvest

David Ray Velez, MD

Table of Contents

Techniques:
Open Vein Harvest
Endoscopic Vein Harvest (EVH)

The Great Saphenous Vein (GSV) is the Most Commonly Used Bypass Vein in Vascular Trauma and Coronary Artery Bypass Grafting (CABG) 

In Lower Extremity Trauma the Contralateral Vein is Preferred

Great Saphenous Vein (GSV)

Open Vein Harvest

The Standard Technique in Traumatic Injury

Technique

  • Can Use an Ultrasound to Precisely Identify and Mark the GSV Course and Target Incisions Before Hand
  • Make an Incision Along the Vein – Either a Single Long Incision or Sequential Stepladder Incisions Along Its Length
  • Identify and Dissect the Vein
  • Clip or Tie Any Side Branches
  • Continue Dissection to the Desired Length
  • Ligate the Proximal and Distal Ends
  • Graft is Removed and Incision is Closed

Graft Preparation

  • Pressurize the Graft with Heparinized Saline to Identify Any Leaks – Repair with Suture or Clips
  • Options to Avoid Issues with Vein Valves Before Grafting:
    • Reverse the Direction
    • Perform Valvulotomy with a Valvulotome – A Catheter/Instrument with a Blade at the End that Destroys the Valves without Damaging the Graft
  • Spatulate the Ends to Widen the Anastomosis and Limit Risk of Stricture

Open GSV Harvest 1

Endoscopic Vein Harvest (EVH)

Primarily Used for Coronary Artery Bypass Grafting (CABG) and Not Generally Used in the Setting of Trauma

Basic Technique

  • A Small 2-3 cm Skin Incision is Made by the Medial Tibial Tuberosity
  • Identify and Dissect the GSV
  • Advance a Balloon Port into the Tunnel and Carbon Dioxide Insufflation is Used to Keep the Tunnel Open
  • Endoscope is Inserted into the Tunnel
  • Small Branches are Ligated by Endoscopic Electrocautery
  • Dissect Above and Below the Knee as Needed for the Required Length
  • Make Small Incisions at the Most Proximal and Distal Sites (Groin and Medial Malleolus) to Access and Transect the GSV
  • Graft is then Removed
  • Incisions are Closed

Graft is Then Prepared and Used in Similar Fashion to an Open Vein Harvest

Endoscopic Vein Harvest 2

References

  1. Correa JA, de Abreu LC, Pires AC, Breda JR, Yamazaki YR, Fioretti AC, Valenti VE, Vanderlei LC, Macedo H Jr, Colombari E, Miranda F Jr. Saphenofemoral arteriovenous fistula as hemodialysis access. BMC Surg. 2010 Oct 18;10:28. (License: CC BY-2.0)
  2. Kopjar T, Dashwood MR. Towards Endoscopic No-Touch Saphenous Vein Graft Harvesting in Coronary Bypass Surgery. Braz J Cardiovasc Surg. 2022 Sep 2;37(Spec 1):57-65. (License: CC BY -4.0)