Interact CardioVasc Thorac Surg 2008;7:191. doi:10.1510/icvts.2007.166645A
© 2008 European Association of Cardio-Thoracic Surgery
eComment: Long saphenous vein harvesting and recurrences
Narcis Hudorovic
University Hospital Sestre Milosrdnice, Zagreb 10000, Croatia
Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity
There are primary end-point and secondary end-points in this study [1], but what has happened with recurrences?
Mapping of a venous system was started more than a decade ago to ensure reproducibility over time. A map of the vein system and circulation defects of the lower limbs is used in CHIVA (type 1 + 2) interventions and traditional surgical procedures. Incorrect application of these concepts – especially on an anatomical basis – can leave the way open to recurrences. The long-term results of surgical interventions on venous systems depend on correct diagnosis. If the hemodynamic status of the venous systems are properly identified, an appropriate treatment plan (even harvesting) can be chosen. Radical surgery, such as [LSV] harvesting for coronary artery bypass surgery (CABG), defined as physical extraction of the LSV with ligation of all its collaterals and all the eventually existed enlarged varices, which has been the surgical procedure of choice for varicose veins for almost a century, has been replaced by a radical hemodynamic approach, meaning elimination of the hemodynamic defects at the root of the formation of the recurrences (the reflux). Duplex ultrasonography has become the method of choice to investigate morphology and hemodynamic properties of vein systems. However as has been shown previously [2], competent venous valves make the method reliable only in proximal vein segments with just one competent valve above the area investigated. The proximal leg veins are circular in the supine position during normal breathing as well as during a Valsalva manoeuvre [3] and the diameter in transverse section corresponds well to the assessed in the sagittal plane. As a consequence, venous diameters measured in the supine position are reliable parameters for the assessment of the vessel area. Further investigations should also address the issue of distensibility measurements in more distally located vein segments. The different behavior of wall sections at different distances from the valve leaflet origin might give us further insights in the pathophysiology of LSV. Changes of the biophysical properties of the venous wall (elastic fibre degradation) may be the reason for increased distensibility (recurrences).
It would be interesting to quantify the ultrastructural changes of the vein wall and relate this to the impaired wall motion. The investigation of venous wall distensibility could also be a tool for follow-up measurements of wall remodeling processes (recurrences).
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References
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- Luckraz H, Lowe J, Pugh N, Azzu AA. Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity. Interact CardioVasc Thorac Surg 2008;7:188–191.[Abstract/Free Full Text]
- Jeanneret C, Labs K, Aschwanden M, Bollinger A, Hoffmann U, Jager F. Physiological reflux and venous diameter change in the proximal lower limb veins during a standardized Valsalva manoeuvre. Eur J Vasc Endovasc Surg 1999;17:398–403.[CrossRef][Medline]
- Jeanneret C, Labs K, Aschwanden M, Gehrig A, Jager K. Measured versus calculated venous cross sectional area assessed by duplex-sonography in lying and standing healthy subjects. Eur J Ultrasound 2000;21:16–19.
Related Article
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Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity
- Heyman Luckraz, Julie Lowe, Neil Pugh, and Ahmed A. Azzu
Interactive CardioVascular and Thoracic Surgery 2008 7: 188-191.
[Abstract]
[Full Text]
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