Surgeon’s Focussed Ultrasound Examination of the Long Saphenous Vein Reduces Surgical Time and Wound Complications

• Published in: Heart, lung & circulation lung & circulation, 2019-11, Vol.28 (11), p.1735-1739
• Main Authors: Aguirre, Victor, Connolly, Catherine, Stuklis, Robert, Cullen, Hugh, Viana, Fabiano, Worthington, Michael
• Format: Article
• Language: English
• Subjects: Aged; Conduit harvesting; Coronary Artery Bypass - methods; Coronary bypass graft; Female; Focussed ultrasound; Follow-Up Studies; Humans; Incidence; Male; Operative Time; Retrospective Studies; Saphenous Vein - diagnostic imaging; Saphenous Vein - transplantation; South Australia - epidemiology; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Tissue and Organ Harvesting - methods; Ultrasonography - methods; Vein conduit; Vein harvesting
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2018.09.012

Despite increased use of arterial grafts, the long saphenous vein (LSV) is often utilised as conduit for coronary artery bypass graft (CABG). Preoperative ultrasound (U/S) vein assessment is limited to patients with varicosities, clinical signs suggestive of poor vein conduits and a history of cardiac or vascular surgery. The aim of this study was to evaluate the usefulness and logistics of the surgeon incorporating intraoperative U/S assessment of the LSV into their regular practice. All patients undergoing coronary artery revascularisation and open vein harvest in our institution were recruited from July 2016 to February 2017. Demographics, including known risk factors for wound complications were documented, in addition to surgical details such as harvest time, vein length and surgical repairs of the conduit. Focussed U/S assessment was performed intraoperatively by the surgical registrar before beginning the procedure. The diameter of the leg pre and postoperatively, as well as the incidence, type and severity of wound complications were documented for further statistical analysis. A total of 103 patients were included in this study. Two patients died perioperatively and were excluded from the study. The remaining 101 patients were separated in two cohorts—U/S group (n=32) and blind technique group (n=69). Demographics were similar between the groups, whilst other risk factors for harvest complications, such as presence of superficial varicosities on clinical examination and renal failure were significantly more frequent in the U/S group. The median harvest time was significantly lower within the U/S group (25 mins versus 40 mins; p=0.001), as was the rate of overall wound complications (6.2% vs 23.2%; p=0.04). Ultrasound assessment of the LSV by the surgical team intraoperatively is feasible, easy to learn and does not demand extra costs or delays. It significantly reduces surgical harvest time and it is associated with a reduced incidence of wound complications, swelling and postoperative mobility impairment.