Saphenous vein graft: Difference between revisions

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==Saphenous Vein Graft Diseases==
==Saphenous Vein Graft Diseases==
===Venospastic Phenomena of Saphenous Vein Bypass Grafts===


===Saphenous Vein Graft Aneurysms===
===Saphenous Vein Graft Aneurysms===

Revision as of 01:39, 5 April 2009

Saphenous vein graft

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

Normal Anatomy

The great saphenous vein (GSV) originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot.

After passing anterior to the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone.

The great saphenous vein then courses laterally to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening. It joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction.

The small saphenous vein (also lesser saphenous vein) is originated where the dorsal vein from the fifth digit (smallest toe) merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein. It is considered a superficial vein and is subcutaneous (just under the skin). From its origin, it courses around the lateral aspect of the foot (inferior and posterior to the lateral malleolus) and runs along the posterior aspect of the leg (with the sural nerve), passes between the heads of the gastrocnemius muscle, and drains into the popliteal vein, approximately at or above the level of the knee joint.

Preparation (Saphenous vein harvesting)

Mini Invasive Technique

Side Effects of Saphenous Vein Stripping

  • Saphenous nerve injury

Diagnostic & Evaluation Findings

Coronary Angiography

CT Angiography

MR Angiography

Pathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Saphenous vein coronary bypass graft: Gross, natural color, external view of heart with thrombosed veins


Saphenous vein coronary bypass graft: Thrombosis, Acute: Gross, fixed tissue but well shown cross sections of bypass graft and anastomotic site with thrombosis. 61 yo male, with and acute infarct treated with streptokinase and two days later had bypass. Died 5 days post op. Two veins are thrombosed


Myocardial Infarct Acute Reflow Type: Gross, fixed tissue but good color. A very enlarged heart with moderate LV dilation and high anterior wall hemorrhagic infarct. Initially treated with streptokinase and two days later had saphenous vein grafts. Both grafts are thrombosed. He died after 5 days









Saphenous Vein Graft Diseases

Venospastic Phenomena of Saphenous Vein Bypass Grafts

Saphenous Vein Graft Aneurysms

It is also known as SVGA, aortocoronary saphenous vein graft aneurysms, saphenous vein graft aneurysm disease and saphenous vein graft aneurysmal dilatation.

Causes of Saphenous Vein Graft Aneurysms

Saphenous Vein Graft Degeneration

Saphenous Vein Graft Occlusion

Treatment

Thrombolysis

PCI

Plain Old Balloon Angioplasty (POBA)
Bare Metal Stents
Drug Eluting Stents
Excimer Laser Coronary Angioplasty (ELCA) of Saphenous Vein Grafts

At the end of 80's [1], ELCA was introduced and thought to be particularly suitable for saphenous vein grafts that were otherwise difficult to treat with balloon angioplasty alone.[2]

Surgery (Re-do)

Videos

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References

  1. Litvack F, Grundfest WS, Goldenberg T, et al. Percutaneous excimer laser angioplasty of aortocoronary saphenous vein grafts. J Am CoIlCardiol 1989; 14:803-8.
  2. Bittl JA, Sanborn TA, Tcheng JE, et al. Clinical success, complications and restenosis rates with excimer laser coronary angioplasty. Am J Cardiol 1992; 70:1533-9.

See Also

External Links

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