Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#8 SAPHENOUS VEIN HARVEST IS ASSOCIATED WITH LOWER EXTREMITY VEIN THROMBOSIS IN A POSTOPERATIVE POPULATION
Paul A. Skudder, MD, Robert Blumenberg, MD, Michael Gelfand, MD, and Richard Sellick, RVT Ellis Hospital and Sunnyview Hospital Schenectady, NY.
Introduction: Harvest of the saphenous vein for use as a conduit for peripheral and coronary surgery is performed countless times daily. The impact of saphenous vein harvest on risk of superficial or deep venous thrombosis is uncertain. In the event that vein harvest is associated with venous thrombosis, any possible benefit of postoperative anticoagulation in reducing incidence of thrombotic events also bears investigation. We studied the incidence of postoperative venous thrombosis in a "captive" patient cohort, where scanning of all patients could be accomplished.
Methods: Patients entering an inpatient rehabilitation program following bypass surgery with saphenous vein harvest were subjected to routine lower extremity screening for venous thrombosis on admission to the facility. Two years data were accumulated. Incidence of lower extremity venous thrombosis was determined by duplex scan. The influence of ipsilateral vein harvest on risk of thrombosis and the effect of postoperative use of aspirin, heparin or coumadin on the risk of thrombosis were analyzed.
Results: 654 screened patients experienced a 27% incidence of DVT (including both calf and proximal DVT). 31% of patients experienced superficial vein thrombosis. Superficial thrombosis was strongly associated with ipsilateral vein harvest (p<0.0005). Proximal deep vein thrombosis was strongly associated with the presence of ipsilateral superficial thrombosis (p<0.0005). Deep vein thrombosis was also associated with vein harvest (p<0.03). Superficial thrombosis was seen to originate in a stump of proximal saphenous vein and to propagate into the deep system at the saphenofemoral junction in several cases. A trend toward reduced risk of DVT (p<0.07) was seen in patients treated with aspirin, heparin or coumadin.
Conclusions: Ipsilateral saphenous vein harvest is associated with significant increase in risk of superficial vein thrombosis, which in turn carries increased risk of DVT. This may be decreased by postoperative use of anticoagulant medications.
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Last updated January 10, 1999