Prediction of long saphenous vein graft adaptation

The ability of vein to dilate may allow smaller veins to be used for bypass if this change could be predicted. Sixty patients undergoing femorodistal popliteal or infrapopliteal bypass have had their long saphenous vein studied. Diameter measurements of the long saphenous vein have been performed using an ATL Duplex scanner at the groin, mid-thigh and knee. Measurements were performed preoperatively both at rest and with a venous occlusion cuff to dilate the vein and subsequently at 7 days and 3, 6, 9, 12 months after implantation. The mean diameter of the vein at the mid thigh was 4.2 mm non dilated, 5.1 mm with occlusion, 5.4 mm 7 days postoperatively and 5.5 mm at 12 months (p < 0.01 ANOVA). The mean diameter of the vein at the knee was 3.8 mm non-dilated, 4.8 mm with occlusion, 4.8 mm at 7 days and 5.0 mm at 12 months after operation (p < 0.01 ANOVA). If the minimum resting internal diameter of vein regarded as being suitable for bypass was 3 mm, this technique would have increased the vein utilisation rate by 22%. These results show that by using a technique of venous occlusion at the time of preoperative vein mapping the adaptive response of the vein can be predicted and this can result in an increased rate of vein utilisation.