Selection of Saphenous Vein Conduit in Varicose Vein Disease

Short-Term Results of Varicose Vein Graft Used for Lower-Limb Bypass Surgery

Objective: Due to the potential of thrombus blockage and aneurysm rupture, saphenous veins with varicose veins are not advised for use as bypass grafts. However, if no other autologous vein is accessible for use as a conduit in lower-limb bypass; varicose vein transplants may be employed. Few reports have studied the clinical results of lower-limb bypass using varicose vein grafts. We therefore investigated whether or not acceptable patency rates of varicose vein graft for lower-limb bypass could be achieved. Methods: We performed lower-limb bypass using varicose vein graft on nine limbs from June 2017 to May 2020 and conducted a retrospective analysis of prospectively collected data. Results: Early graft failure following bypass surgery using a varicose vein transplant was not detected, and major complications, such as acute graft occlusion or aneurysm dilatation, were not noted throughout the follow-up period. The primary and secondary patency of varicose vein graft was 70.0% and 100% at 3 years, respectively. Conclusion: The incidence of major problems of the varicose vein transplants does not seem to be higher than with conventional saphenous vein grafts. If there are no other appropriate autologous veins, a varicose vein graft may be useful as a conduit for bypass surgery.

Ethics and rationale for sparing the saphenous vein

Not available.

Saphenous vein characteristics evaluated using three-dimensional contrastless computed tomography before coronary artery bypass grafting

OBJECTIVE

Saphenous vein (SV) grafts are occasionally unsuitable for grafting owing to anatomic variants. However, there is some concern regarding preoperative SV evaluation. We used contrastless 3D-CT to investigate the anatomical SV characteristics before CABG.

METHODS

Contrastless 3D-CT was used to preoperatively evaluate the SV anatomy in 102 consecutive patients undergoing elective first-time CABG. The external diameter of the SV was measured at the mid-level of the thigh and calf segments on both sides. Abnormal branches of the SV were classified into three categories; (1) partial duplication, which was defined as double SVs; (2) large accessory SVs, which were larger than the great SV; and (3) complicated branches of the SV, which resulted in the great SV being undetected. The existence of varicose veins was assessed.

RESULTS

The size distribution of the SV (< 3 mm/3-5 mm/5 mm <) was 9/142/53 and 17/154/33 in the thigh and calf segments, respectively. Abnormal branches of the SV were found in 47 patients (46%): (1) partial duplication was noted in 40 patients; (2) large accessory SV was observed in eight patients; and (3) complicated branches were identified in five patients. Varicose veins were detected in 15 patients. SV was harvested in 74 patients, and no additional skin incision was required.

CONCLUSIONS

Contrastless 3D-CT is an objective, less time-consuming modality to preoperatively evaluate the SV, and may be less invasive in terms of avoiding unnecessary skin incision. This technique is useful for defining atypical anatomical variations, such as partial duplications, large accessory SVs, and varicose veins.

Distal bypass with a varicose vein graft for critical limb ischemia: report of a case

BACKGROUND

A saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting.

CASE PRESENTATION

A patient who developed sepsis due to lower limb gangrene was successfully treated by endovascular treatment and bypass surgery using a varicose vein graft. There were no complications, such as occlusion or aneurysm, of the varicose vein graft during the 2-year follow-up period.

CONCLUSIONS

We herein report a case in which bypass surgery with a varicose vein graft was used to avoid major amputation of the lower limb, and the patient recovered markedly from sepsis. If there are no other appropriate autologous veins for revascularization of lower limb gangrene, a varicose vein graft may be useful as a conduit for bypass surgery at risk of graft infection.

Evaluation of autologous tissue sources for the isolation of endothelial cells and adipose tissue-derived mesenchymal stem cells to pre-vascularize tissue-engineered vascular grafts

Currently used synthetic vascular grafts bear a high infection risk due to insufficient microvascularization of the graft wall disabling the infiltration of immune cells. Tissue-engineered grafts with a functional pre-vascularization thus would be desirable. However, autologous tissue sources for capillary forming cells need to be evaluated. Here, peripheral blood outgrowth endothelial cells (PB-OEC) from 17 healthy donors and pericyte-like mesenchymal stem cells derived from adipose tissue (ASC) of 17 patients scheduled for visceral surgery were characterized and investigated regarding their ability to form capillary-like networks in plasma-derived fibrin gels. To obtain proliferating PB-OEC with endothelial cell-specific properties (CD31-, VE-cadherin-expression, ac-LDL uptake and three-dimensional (3D)-tube formation in fibrin gels) both enrichment of CD34

Ultrasound mapping of the long saphenous vein in coronary artery bypass graft surgery

Long saphenous vein is the most common conduit utilized for surgical coronary revascularization. Ultrasound-assisted vein assessment is superior to traditional clinical examination of the long saphenous vein in discerning path and suitability for use as a conduit. Preoperative ultrasound mapping of the long saphenous vein is easy and rapidly accomplished allowing optimal surgical site selection, avoiding unnecessary surgical dissection and potential wound complications. We describe the technique of ultrasound mapping of the long saphenous vein and its application to conduit harvest in coronary artery bypass graft (CABG) surgery.

Could routine saphenous vein ultrasound mapping reduce leg wound complications in patients undergoing coronary artery bypass grafting?

A best evidence topic was written in cardiothoracic surgery based on a structured protocol. The question addressed was whether ultrasound mapping of the long saphenous vein (LSV) might reduce leg wound complications by reducing unnecessary leg incisions due to poor quality veins. Altogether, 32 abstracts were identified from the search, from which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Surgical site infections can be extremely distressing for patients, and it is estimated that treating a surgical wound can cost up to £1554 each. Ultrasound mapping of the LSV has been reported to be an accurate way of assessing vein quality preoperatively, reducing unnecessary surgical dissection, theatre time and cost to both the patient and the health service. We identified four studies that showed that ultrasound scanning preoperatively could accurately predict the anatomy and quality of the LSV (correlation coefficient 0.87). One paper showed that ultrasound scanning reduced length of incision (P = 0.005), harvest time (P = 0.04) and hospital stay and reduced morbidity (although not statistically significant). However, one study found that it could not accurately predict vein wall changes. Evidence from the papers supports the use of preoperative ultrasound assessment of the saphenous vein. Benefits to the patient include a smaller scar, reduced harvest time and minimizing unnecessary incisions.

[Segmental variations of great saphenous vein diameters in a coronary triple vessel disease population]

BACKGROUND

Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations.

PATIENTS AND METHODS

Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance.

RESULTS

Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters.

CONCLUSION

This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.

Autologous Blood Vessels Engineered from Peripheral Blood Sample

OBJECTIVE

Although many efforts have been made to generate small-diameter (< or =5mm) vascular grafts by means of tissue engineering, improvement in patency and functionality still remains a great challenge. It is our hypothesis that to achieve long-term functionality and patency, not only the complete lining with endothelial cells but also full biocompatibility is essential.

DESIGN

The aim was the development of a conduit from a scaffold and endothelial progenitor cells (EPC) separated from peripheral blood of a single donor.

MATERIALS AND METHODS

EPC and a fibrin preparation were separated from porcine peripheral blood. Fibrin segments were generated seeded with EPC and were perfused in a bioreactor in vitro.

RESULTS

From 100ml blood 12-15 cm long fibrin tubes were successfully generated lined with endothelial-like cells. Seeded tubes showed a remarkable elasticity and burst strength up to 90 mm mercury.

CONCLUSIONS

Stable fibrin tubes were successfully generated completely lined with an endothelium-like monolayer from fibrin and EPC, both isolated from the same volume of blood. Although their stability is not those needed for arterial grafting, our results raise the hope, that with distinct improvements in future studies functional autologous vascular grafts could be engineered from the patient's own blood.