Use of Doppler Ultrasound for Saphenous Vein Mapping to Obtain Grafts for Coronary Artery Bypass Grafting

Abstract

IntroductionThe great saphenous vein is widely used as a graft in coronary artery bypass grafting surgery. Complications due to saphenous vein harvesting can be minimized when using ultrasonography mapping and marking.ObjectiveTo analyze by clinical trial the use of vascular ultrasonography to map the saphenous vein in coronary artery bypass grafting to determine viability and dissection site.MethodsA total of 151 consecutive patients submitted to coronary artery bypass surgery with the use of the great saphenous vein as a graft were selected for this prospective study. They were divided into two groups: Group 1 - 84 patients were submitted to ultrasonographic mapping and marking of the saphenous vein; Group 2 - 67 patients had saphenous vein harvested without any previous study. Both groups were coupled with follow-up on the 1st, 5th and 30th postoperative days. Primary endpoints were need for incision of the contralateral leg and wound complications within 30 days.ResultsBoth legs had to be incised in 6 (8.95%) patients from Group 2 (P=0.0067). Wound complications occurred in 33 (23.4%) patients within 30 days, 21 (35%) from Group 2 e 12 (14.8%) from Group 1 (OR 3.095, 1.375-6.944, CI 95%, P=0.008). Within 30 days there were 4 (2.8%) deaths, all in Group 2 (P=0.036).ConclusionThe use of vascular ultrasonography for mapping of the great saphenous vein in coronary artery bypass surgery has properly identified and evaluated the saphenous vein, significantly reducing wound complications and unnecessary incisions. It would be advisable to use this noninvasive and easy to use method routinely in coronary artery bypass surgery.

Learning process and results in endoscopic saphenous vein harvesting technique

“…We think that the significant reduction in this injury is related to gaining the ability to maneuver more easily, to work faster and to solve potential problems by mastering the instruments used during EVH application with experience. In addition, it has been shown that gaining surgical skills to prepare endoscopic SVG and knowing in detail about the anatomy of the VSM facilitate the procedure [34]. In our study, we preferred to use preoperative and intraoperative ultrasonography for less manipulation of tissues and SVG.…”

Effect of preoperative ultrasound mapping of the saphenous vein on leg wound complications after coronary artery bypass surgery: a systematic review

“…The possible risk of bias was assessed using either the Cochrane Risk of Bias Assessment [18] or the ROB-INS-I tool [19] for the RCTs [20,21] and non-RCTs [6,12,22], as appropriate (Table 1). Both risk of bias assessment tools include several domains whereby in which regard each study is evaluated independently.…”

“…Of 4514 papers screened in this systematic review, 36 papers underwent full-text assessment with final inclusion of five studies [6,12,[20][21][22] (Fig. 1).…”

“…1). Of the five included studies, two were RCTs [20,21] and three were cohort studies [6,12,22], respectively. Studies were mainly excluded as the outcomes of interest were not reported.…”

“…Only the study by Lopes et al [22] reported the risk for bilateral leg incision. Six patients in the unmapped group (8.95%) required an additional incision, and this outcome did not occur in the mapped group (p = 0.0067).…”