title: Correlation of preoperative ankle-brachial index and pulse volume recording with impaired saphenous vein incisional wound healing post coronary artery bypass surgery.
abstract: Patients undergoing coronary artery bypass surgery have vascular disease and, subsequently, the risk for impaired healing of their saphenous vein graft site. The purpose of this study was to identify the correlation of the preoperative ankle-brachial index (ABI) and pulse volume recording (PVR) with impaired saphenous vein incisional wound healing post coronary artery bypass grafting. A prospective, correlational research design was used to study 271 male and female adults undergoing coronary artery bypass surgery in which the saphenous vein was used for grafting. Arterial insufficiency was assessed preoperatively using patient history, physical examination, ABI, and PVR. Wound status was assessed postoperatively using the validated ASEPSIS tool for inpatients. A modified ASEPSIS tool, the Wound Healing Self Score, was used for telephone follow-up post discharge. Abnormal ABI and PVR measurements were positively correlated with impaired saphenous vein incisional wound healing (r = 0.72, P < .0001). Both tests also independently predicted impaired healing. Incisional infection correlated with impaired healing (P < .0001). Other clinical variables, including diabetes, hypertension, venous disease, and alcohol and cigarette use, were not found to be statistically significant independent predictors of impaired healing. Routine histories and physical examinations alone are insufficient in predicting risk for impaired saphenous vein incisional wound healing. The addition of noninvasive screening for the presence of arterial insufficiency before coronary artery bypass grafting using ABI and PVR tests is one method of predicting the likelihood of impaired healing.
authors.affiliation: Mayo Clinic, Rochester, Minnesota 55901, USA. haraden.jamie@mayo.edu
authors.forename: Jamie
authors.initials: J
authors.lastname: Haraden
authors.forename: Connie
authors.initials: C
authors.lastname: Jaenicke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001810:Blood Volume; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009730:Nursing Assessment; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000451:nursing / Q000592:standards; D011446:Prospective Studies; D011674:Pulse; D015203:Reproducibility of Results; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013530:Surgical Wound Infection / Q000209:etiology*; D014463:Ultrasonography; D014945:Wound Healing