Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity

Abstract

Long saphenous vein harvesting for coronary bypass surgery is associated with significant morbidity. Furthermore, vein quality is often variable sometimes requiring incisions in both legs. This prospective randomised control study assessed the usefulness of pre-operative long saphenous vein mapping in terms of conduit quality and location, incision lengths and post-operative morbidity. The long saphenous vein was assessed and mapped pre-operatively (n=31) by venous Doppler ultrasound or not (n=30). The size and anatomical distribution of the long saphenous vein was well predicted by the ultrasound study (correlation coefficient=0.87). Intra-operatively, the mean length of leg wound incision per vein graft performed was significantly less in the mapped group [16.8 (4.0) vs. 24.1 (10.4) cm, P=0.005]. This translated in a shorter operative time for vein harvesting per length of vein graft needed [36 (13) vs. 47 (17) min, P=0.04]. Post-operatively there was a tendency to less leg wound complications in the mapped group (P=0.08) and earlier hospital discharge (median length of stay 6.5 days vs. 8.0 days, P=0.05). Thus, long saphenous vein mapping pre-operatively predicted the size and anatomy of the vein appropriately. This led to a selective leg wound incision and reduced operative time with the benefit of reduced leg complication post-operatively.