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The Utility Of Great Saphenous Vein Mapping In The Detection Of Superficial Vein Thrombosis Prior To Infrainguinal Arterial Bypass
Melissa C. Hetrick, DO, Ashley E. Beale, MD, Graham W. Long, MD, Sarvar Oreizi-Esfahani, Rose E. Callahan, Diane M. Studzinski, Otto W. Brown, MD.
Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.

OBJECTIVE: The great saphenous vein (GSV) is widely used as a bypass conduit for the treatment of infrainguinal peripheral arterial disease. Preoperative vein mapping assesses both the quality and diameter of the GSV. Ultrasound findings regarded as unfavorable are the presence of superficial vein thrombosis (SVT), ipsilateral deep vein thrombosis (DVT), and small vessel diameter. Identifying a suitable conduit is of utmost importance as GSV bypasses have improved patency compared to alternative conduits. The primary objective of this study was to identify the percentage of patients with ipsilateral SVT as well as patient characteristics associated with SVT and unsuitable GSV.
METHODS: Retrospective, single-institution study from March 2013-December 2021. All patients with peripheral arterial disease who underwent outpatient vein mapping were included. Unsuitable GSV was defined by the presence of SVT, DVT, or size < 2.5 mm in any segment (from proximal thigh to distal calf).
RESULTS: A total of 191 patients met inclusion criteria. Most patients were male (71.7%), Caucasian (69.8%), and the mean(SD) age was 68.6(10.8) years. Ipsilateral SVT was identified in 10.5% of patients. No significant differences in demographics or comorbidities were identified in patients with and without ipsilateral SVT. Less than half (45.8%) of patients had GSV that was greater than 2.5 mm throughout, and only one third (37.4%) had a GSV conduit of adequate size without SVT or ipsilateral DVT. GSV conduits of adequate size and without SVT or ipsilateral DVT were associated with male gender, 86.6% male vs 13.4% female (p=0.001, OR 3.6 (95% CI 1.6-8.2)). After completion of vein mapping, 90 (62.1%) patients underwent infrainguinal bypass and the ipsilateral GSV was used as a conduit in 58.9% of cases.
CONCLUSIONS: Our study revealed that 10.5% of patients have SVT identified on preoperative vein mapping. Given these findings, routine preoperative venous duplex should be performed to assess for the presence of SVT, as this finding is difficult to identify intraoperatively and may predict lower patency rates. Veins identified as unsuitable, based on size criteria alone, should still be investigated intraoperatively with ultrasound or direct surgical exploration as vessel diameter, unlike SVT, is a dynamic finding.
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