Best Hospitals for Endoscopic Vein Harvesting in Mumbai, India

Coronary artery disease (CAD) results from atherosclerotic plaque accumulation within the coronary arteries, progressively reducing myocardial perfusion and precipitating angina, myocardial infarction, and ultimately heart failure. When multi-vessel disease is confirmed — typically defined as involvement of two or more major coronary vessels or left main stenosis exceeding 50% — coronary artery bypass grafting remains the gold-standard revascularization strategy, demonstrating superior 10-year survival outcomes over percutaneous coronary intervention (PCI) in patients with diabetes, reduced ejection fraction, or complex anatomical disease as stratified by the SYNTAX score.

• ELIGIBLE PATIENTS:
• Patients diagnosed with multi-vessel coronary artery disease (2- or 3-vessel disease) confirmed on coronary angiography with SYNTAX score typically >22, where CABG is preferred over PCI
• Patients with left main coronary artery stenosis ≥50%
• Patients with CAD and comorbid Type 2 diabetes, where CABG demonstrates a proven long-term survival advantage over stenting (FREEDOM trial data)
• Patients with reduced left ventricular ejection fraction (LVEF 35–50%) requiring surgical revascularization
• +23 more

STANDARD OPEN VEIN HARVESTING (Conventional — Reference Technique): The traditional method requires a continuous longitudinal incision from the ankle or mid-calf to the upper thigh, spanning 30–60 cm. The saphenous vein is directly visualized, side branches ligated with sutures or clips, and the vessel excised. While offering direct tactile feedback, this technique carries wound infection rates of 2–5%, significant postoperative leg pain, risk of delayed healing especially in diabetic patients, and prolonged functional recovery of the donor leg.

MINIMALLY INVASIVE ENDOSCOPIC VEIN HARVESTING (EVH — Current Preferred Standard): EVH is performed through 1–3 small (1–2 cm) incisions at strategic anatomical points along the saphenous vein tract. A dedicated endoscopic harvesting device — most commonly the LeMaitre VasoView system, the Terumo Clearglide system, or the Ethicon Vasoview Hemopro — is advanced through a subcutaneous tunnel. The system integrates a high-definition endoscopic camera, CO2 insufflation (pressurized to 10–12 mmHg to create working space), and bipolar or ultrasonic electrocautery for hemostatic side-branch division.

- CO2 Insufflation-Based (Closed Tunnel) EVH: The dominant technique. A sealed tunnel is created subcutaneously, inflated with CO2 gas, and side branches are divided under endoscopic visualization with electrocautery. Offers excellent visualization, reduced tissue trauma, and the lowest wound complication profile.

- Mechanical Retractor-Based (Open Tunnel) EVH: Uses a mechanical retractor rather than CO2 inflation to create the working space. Some surgeons prefer this in patients where CO2 absorption is a concern. Slightly higher wound complication rate than closed CO2 EVH in meta-analyses.

PRE-OPERATIVE PHASE (Days -7 to 0 — At Home and In Destination Country):

• Step 1 — Remote Medical Review (Before Travel): Patient submits coronary angiography reports, ECHO results, blood work, and surgical history to GAF Healthcare's medical coordination team. Partner hospital cardiologist and cardiac surgeon conduct a tele-consultation to confirm candidacy, calculate EuroSCORE II/STS risk, and finalize operative plan (number of grafts, conduit strategy).
• Step 2 — Arrival and Pre-Admission Workup (Days 1–2): Patient arrives in India or UAE. GAF Healthcare arranges airport pickup and hotel or hospital guesthouse accommodation. Hospital admission for comprehensive pre-operative workup: repeat ECHO, duplex ultrasound vein mapping, anesthesia consultation, hematology panel, chest X-ray, ECG. Anti-platelet therapy (aspirin, clopidogrel/ticagrelor) is strategically discontinued per anesthesiology protocol — typically 5–7 days prior if not already stopped.
• Step 3 — Cardiac Surgery Team Consultation (Day 2–3): Formal pre-operative consultation with the lead cardiac surgeon. Informed consent for CABG with EVH. Surgical plan finalized: number of bypass grafts (typically 2–4), conduit allocation (LIMA + saphenous vein EVH ± radial artery), on-pump vs. off-pump strategy.

INTRA-OPERATIVE PHASE (Operative Day — Approximately 4–6 Hours Total):