[MSCT-navigation in planning reconstructive operations on peripheral arteries using saphenous veins]
D V Breev1, E V Rosseikin1, M G Maslov1
1Federal Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 680009, Khabarovsk, Russian Federation.
Introduction:
Currently, there is a significant arsenal of means for restoring blood flow in occlusive lesions of limb arteries. The great saphenous vein is recognized to be an optimal material. Traditionally during computed tomography angiography, we perform visualization of only the arterial bed, leaving the venous subcutaneous system unexamined. In our work, we demonstrated the use of volumetric 3D multislice spiral computed tomography (SCT) imaging as an objective and minimally time-consuming method of preoperative assessment of the great saphenous vein as a would-be conduit. It was shown that this method of diagnosis is of particular value in difficult situations such as formation of arteriovenous anastomoses while creating an access for hemodialysis, distal reconstructions of lower-limb arteries, repeat reconstructions of limb arteries.
Objective:
To propose and substantiate the use of the method of volumetric 3D MSCT for verifying the state of lower-extremity subcutaneous veins in preliminary planning of the course of reconstruction of major arteries using limb saphenous veins.
Patients And Methods:
The standard SCT-angiography in the framework of a single study was supplemented by extended slice-by-slice visualization of soft tissues and examination of the subcutaneous venous network. Such an approach made it possible to preoperatively measure the diameter and length of the vein, to determine the dimensions and number of its tributaries. The obtained diagnostic information allows it to more reliably assess the possibility of using the great saphenous vein for reconstructive operation or reject it as a conduit. When planning in situ bypass, we applied this method of diagnosis to assess localization of large tributaries. This method was used in a total of 55 patients: 36 reconstructions on lower limbs, 4 - on upper limbs, 12 - in patients on hemodialysis and 3 - in reconstructions of visceral arteries.
Results:
In all patients included into the study, the planning of the operation was adequate, comfortable and reliable.
Conclusion:
The proposed method of visualizing subcutaneous veins based on layer-by-layer comparison of limb vessels turned out to be highly valuable from the point of view of precise planning of reconstructive operations using the great saphenous vein, especially in repeat reconstructions.
