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

Abstract Introduction: The 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. Objective: To 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. Methods: A 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. Results: Both 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). Conclusion: The 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.摘要 引言：大隐静脉（great saphenous vein）是冠状动脉旁路移植术（coronary artery bypass grafting surgery）中常用的移植物。采用超声成像（ultrasonography）进行血管定位与标记，可最大限度减少大隐静脉获取术相关并发症。 研究目的：本临床试验旨在分析血管超声成像在冠状动脉旁路移植术中用于大隐静脉定位，以判断其活性及剥离位点的应用价值。 研究方法：本前瞻性研究共纳入151例连续入组、以大隐静脉作为移植物行冠状动脉旁路移植术的患者，将其分为两组：第1组（84例）术前行大隐静脉超声定位与标记；第2组（67例）未行任何术前检查即行大隐静脉获取术。两组患者均于术后第1、5及30天接受随访。本研究的主要终点为需行对侧腿部切口的情况，以及术后30天内的切口并发症。 研究结果：第2组中有6例（8.95%）患者需行双侧腿部切口，组间比较差异具有统计学意义（P=0.0067）。术后30天内共33例（23.4%）患者出现切口并发症，其中第2组21例（35%）、第1组12例（14.8%）（优势比[OR] 3.095，95%置信区间[CI] 1.375~6.944，P=0.008）。术后30天内共4例（2.8%）患者死亡，均发生于第2组（P=0.036）。 研究结论：在冠状动脉旁路移植术中应用血管超声成像进行大隐静脉定位，可准确识别并评估大隐静脉状态，显著降低切口并发症及不必要的腿部切口。建议在冠状动脉旁路移植术中常规推广这一无创且操作简便的方法。