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Accessory and great saphenous veins as coronary artery bypass conduits

^a Department of Surgery, Sutter Medical Center of Santa Rosa, 5773 Shiloh Ridge, Santa Rosa, CA 95403, USA
^b Department of Anatomy, University of Rome ‘La Sapienza,’ Rome, Italy

*Corresponding author. Tel.: +1 707 578 6714; fax: +1 707 578 6701.

E-mail address: jcohn{at}alum.mit.edu (J.D. Cohn).

Anatomic, histologic and ultrasound studies demonstrate two distinct types of longitudinal veins in the lower extremities. The great saphenous vein is deep to the saphenous fascia. Accessory saphenous veins are superficial to this layer, have thin walls with diminished muscle cells and elastic fibers. Vein characteristics may affect long-term graft patency. This study assesses the incidence of accessory saphenous veins in various patient groups and evaluates issues related to their use as coronary conduits. Ultrasound imaging assessed great and accessory saphenous veins in 476 normal limbs, in 42 patients post-saphenous vein harvesting and in 75 patients undergoing coronary revascularization. Accessory saphenous veins are found in 67% of normal subjects. Intraoperative ultrasound identifies accessory saphenous veins in 54% of limbs, most in the proximal calf where 42% of all accessory vein segments are located. Great saphenous vein segments are more common in males while accessory veins are more common in females. In 54 limbs following saphenectomy, patent great saphenous vein segments are demonstrated in 20%, adjacent to incision sites, indicating use of accessory saphenous veins in these patients. Ultrasound studies at two medical centers document the common occurrence of accessory saphenous veins. Additional studies are required to determine the efficacy of utilizing accessory saphenous vein segments for coronary artery bypass conduits.

Key Words: CABG; Venous grafts; Ultrasound