Novel technique of vein harvesting for reversed saphenous vein bypass graft

• Published in: Journal of Medicine in Scientific Research
• Main Author: Ihab N A. Hanna
• Format: Article
• Language: English
• Published: General Organization of Teaching Hospitals and Institutes 2020-01-01
• Subjects: bypass; graft; great saphenous vein; modified
• Online Access: http://www.jmsr.eg.net/article.asp?issn=2537-091X;year=2020;volume=3;issue=4;spage=286;epage=288;aulast=A.

Background The technique of harvesting the great saphenous vein for bypass procedures may affect the results of the procedure. We describe a simple modification of the vein harvesting technique, which consists of leaving the saphenofemoral junction intact after completion of the proximal anastomosis. This modification allows blood to flow into the vein as soon as the proximal anastomosis is completed, thereby shortening the vein warm ischemia time and allowing the vein to distend with blood rather than saline, under physiologic pressure. This modification aims at improved vein integrity during harvesting and therefore improved graft patency. Patients and methods In this study, 30 patients were subjected to a femoral distal bypass using our modified technique. In this technique, we create a loop with the great saphenous vein being left in continuity at the saphenofemoral junction and the distal end anastomosed to the common femoral artery at the take-off of the bypass graft. The saphenofemoral junction is then ligated and cut after exposure of the distal target arterial exposure and preparation. Results A total of 30 consecutive patients, comprising 16 males and 14 females, were subjected to the technique. Among them, diabetics were 92%, hypertensive 81%, hypercholesteremic 67%, and 60% smokers. Their mean age was 55 years. No adverse effects were observed as a result of using this modification, neither in the form of infection or bleeding nor the increased incidence of cardiac or central complications. A review of the results of 30 consecutive bypass operations performed with the distal anastomosis located at the distal tibial arteries (ankle level) or dorsalis pedis artery using this modified technique showed that the primary 30-day patency rate was 93.1%, at 6 months was 90%, and at 1 year was 87%. Graft patency was documented using a color-flow Duplex scan. Conclusion The use of this modification provides nonpressurized saphenous vein dilation and adequate visualization of bleeding tributaries bleeding under vision, thus adequately controlling them before tunneling, hence minimizing postoperative hematoma with the concomitant possibility of infection.