Optimizing saphenous vein site selection using intraoperative venous duplex ultrasound scanning.
BACKGROUND
Saphenous vein is the most common conduit utilized for coronary artery bypass. However, preoperative noninvasive venous studies to evaluate saphenous vein morphology are not commonly performed due to limited logistical support. A prospective, nonrandomized study was developed to assess the utility of intraoperative saphenous vein duplex ultrasound studies in optimizing saphenous vein site selection.


METHODS
Intraoperative saphenous vein duplex scanning was performed in 58 consecutive patients undergoing coronary artery bypass surgery utilizing two-dimensional ultrasound monitoring equipment. Following anesthetic intubation, studies were performed by one of the surgeons. Most scans were completed in less than 8 minutes.


RESULTS
Findings demonstrate at least 1 venous abnormality in 31 of 116 (26.7%) above knee saphenous veins and 59 of 116 (50.9%) below knee veins. In 38 of 58 patients (65.5%), duplex ultrasound scanning proved beneficial in surgical site selection. Most abnormalities are related to major branches and bifurcations except in the lower calf where small lumen caliber is the most common abnormal finding. Additional beneficial findings include identifying abnormal vein course, identifying suitable conduit in reoperative procedures and precise localization of vein segments for endoscopic surgery.


CONCLUSIONS
Intraoperative saphenous vein duplex scanning is rapidly and easily accomplished with available operating room resources. Study information allows optimal surgical site selection, avoiding unnecessary surgical dissection, time delays, vein wastage and potential for wound complications. Optimizing incision site selection eliminates blind exploration for vein conduit, improves conduit planning, and expedites surgical dissection during endoscopic vein harvest.
Cohn
Joseph D
JD
Department of Surgery, Sutter Medical Center of Santa Rosa, Santa Rosa, California, USA. jcohn@alum.mit.edu
Korver
Keith F
KF
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000637:transplantation*; D018616:Ultrasonography, Doppler, Duplex