Saphenous neuralgia after coronary artery bypass grafting

To determine the incidence, extent and site of saphenous neuralgia (anaesthesia, hyperaesthesia and pain) in the lower limb after harvesting of great saphenous vein (GSV) for coronary artery bypass grafting (CABG).

Thirty-two consecutive patients (39 lower limbs) aged 58+/-16 years undergoing CABG were prospectively reviewed. All patients were assessed pre-operatively to establish the presence of normal sensation, then at 3 days, 6 weeks and 20+/-4 months post-operatively for symptoms or signs of saphenous neuralgia. The data were recorded on serial diagrammatic representations, and the area of sensory loss for each site was recorded at each review. The decrease in areas of sensory loss over time was investigated with statistical analysis.

Thirty-five (90%) of the lower limbs examined showed some degree of anaesthesia at 3 days with 23 (72%) still symptomatic at a mean follow up of 20 months. Hyperaesthesia and pain were infrequently noted. Anaesthesia was generally confined to three main areas, which were denoted sites A, B and C for descriptive purposes. The mean area of sensory loss in the lower limb at 3 days post-surgery was 53.4 cm2, for an incision of mean length 42+/-22 cm from the medial malleolus. This area reduced to 31.7 cm2 by 20 months, and the decrease in area over time for each site was found to be statistically significant using analysis of variance for repeated measures and the Freidman-Rubin test.

This study demonstrates that saphenous neuralgia after harvest of GSV for CABG is common. The main symptom is anaesthesia and certain areas may persist for some considerable time post-operatively.