Vein harvesting

[TheDude]

Howdy all,

 

Have a question for you CV PA folk out there.  Today, I was taking vein doing the EVH thing, and came across a HUGE HUGE branch about mid-thigh.  I left that as the last branch to burn and contemplated going superior and doing my stab-and-grab in case this branch gave me difficulty, I should have listened to my gut.  As I put the cutter/bi-polar across, I did the usual and burn and release, burn and release, then full burn with slight twist.  I've never seen that much blood.  I tried taking the scope and going superior to that but the tunnel was flooded.  I did direct pressure and also tried to re-enter the tunnel.  Couldn't see a thing.  The Surgeon had me open the leg, I have never done that.

 

Is there any good resources out there besides YouTube on how to do open harvest?  I did well and got the vein out and found the branch and he actually had a dual saphenous system.  I just want to have better confidence next time if this happens.  I've only been trained on EVH, so this was a giant learning curve/crap my pants moment.

[CVTSPA]

For big branches like that, I usually make sure I get a lot of length on them during the dissection phase then when I go to cauterize them I hold down the button for 2 seconds at a time about 4 or 5 times with a brief break between each burn to make sure it is well cauterized before I release the jaws.  Then, I flip the jaws so they are facing the opposite direction and do the same thing until it falls on its own.  I'm not fond of doing a twist to break the branches.  Always let the branches, especially the big ones, fall on their own after cauterizing.