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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Cadaveric Analysis of Valvular Anatomy in the Great Saphenous Vein: Implications for Surgical Planning
Schafer Paladichuk1, Alexander Downs1, Zachary Brennan2
1Department of Anatomy, College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, USA.
Insights
The great saphenous vein (GSV) has fewer valves and wider spacing below the knee. This anatomical finding suggests lower leg segments may be better for vein grafts in vascular surgery.
Area of Science:
- Vascular Surgery
- Anatomy
- Biomedical Engineering
Background:
- Coronary artery disease and peripheral vascular disease are major US health concerns.
- Great saphenous vein (GSV) is a common graft conduit, but valve flaps can cause complications.
- Understanding GSV valve anatomy is crucial for improving bypass surgery outcomes.
Purpose of the Study:
- To analyze the anatomical characteristics of the great saphenous vein (GSV).
- Specifically, to determine the distribution and spacing of GSV valves.
- To inform optimal vein graft selection in vascular reconstruction.
Main Methods:
- Examination of 96 great saphenous veins (GSVs) from 66 cadavers (2021-2024).
- Incision and measurement of valve locations relative to the medial malleolus.
- Statistical analysis using Student's t-tests and ANOVA to compare valve distribution.
Main Results:
- An average of 5.7 valves per left GSV and 5.5 per right GSV were identified.
- Significant differences in valve distribution were observed above and below the knee (p<0.001).
- Increased inter-valve distance was noted in the below-knee segments (p<0.001).
Conclusions:
- GSV segments below the knee possess fewer valves and greater inter-valve distance.
- These anatomical features suggest lower leg GSV segments may be more suitable for vascular grafts.
- Findings can guide vein graft selection to enhance surgical outcomes in coronary artery bypass grafting and peripheral vascular bypass procedures.
Abstract:
Introduction and aim Coronary artery disease and peripheral vascular disease remain significant health concerns in the United States. If left untreated, surgical interventions like coronary artery bypass grafting (CABG) and peripheral vascular bypass (PVB) are frequently performed to restore vascular perfusion. The great saphenous vein (GSV) has historically been a primary conduit for these procedures. Complications involving the GSV include early-onset thrombosis and atherosclerosis, which are partly attributed to tunica intima valve flaps. These flaps can disrupt laminar flow even when the GSV is reversed. However, the GSV continues to play a crucial role in multi-vessel revascularization and PVB surgeries. This study aimed to analyze the GSV's anatomical characteristics, particularly the distribution and spacing of its valves. Methods Cadaveric specimens were examined from 2021 to 2024. The GSV was incised, valve locations were marked and measured in relation to the inferior base of medial malleolus. Statistical analyses, including Student's t-tests and ANOVA, were performed to assess differences. Results Results from 96 GSVs across 66 cadavers indicated an average of 5.7 valves per left GSV and 5.5 per right GSV. Significant differences were found between valve distributions above vs. below the knee (p<0.001), with increased inter-valve distance below the knee (p<0.001). Conclusion These data suggest that below knee segments may be more suitable for grafting because they have fewer valves and increased inter-valve distance. This study has the potential to provide insights for optimizing vein graft selection and improving surgical outcomes.
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