Because it is readily accessible and boasts of good long-term patency rates, the greater saphenous vein (GSV) has become a frequent option for grafting in coronary artery bypass surgeries. Proper harvesting of this graft requires careful technique to minimize damage on the vessel and maximize patient outcomes.
Preparation
1. Positioning of Patient:
The patient should lie supine on an operating table with the leg to be harvested slightly elevated.
2. Preoperative Marking:
The course of GSV should be marked out using a skin marker which will help in guiding the surgeon during operation thus reducing unnecessary dissection.
Surgical Technique
1. Incision:
A longitudinal incision is made along the marked route of GSV usually at medial aspect of leg from ankle towards proximal part near groin region if necessary.
2. Dissection:
Subcutaneous tissue is then dissected so as to bring into view the greater saphenous vein (GSV). One must carefully identify and spare any branches such as anterior accessory saphenous vein since these may cause injury to main stem.
3. Vein Harvesting:
Once the GSV is exposed, sharp dissection is used to free it from the surroundings. The vein wall should be traumatized to the least degree possible. However, this should not mean that care to avoid twisting or bending the vessel during harvest should not be taken.
4. Tributary Ligation:
This involves ligation and division of all tributaries to prevent backflow and ensure optimal graft flow in the postoperative period.
5. Vein Transection:
In this step, GSV is cut at an appropriate length usually near saphenofemoral junction (SFJ) around groin area with proximal end being ligated to stop bleeding
6. Closure:
Hemostasis is achieved before closing wound in layers using absorbable sutures for skin closure while staples or sutures can be used depending on surgeon preference.
Postoperative Care
1. Compression:
Compression stockings or bandages are applied to the harvested leg to reduce swelling and promote venous return.
2. Pain Management:
Adequate pain relief is provided to ensure patient comfort postoperatively.
3. Monitoring:
The harvested leg is closely monitored for signs of infection, hematoma, or other complications. Doppler ultrasound may be used to assess graft patency and venous return.
Conclusion
The harvesting of the great saphenous vein is a critical step in coronary artery bypass surgery. A meticulous surgical technique is essential to minimize trauma to the vein and optimize graft function. Proper preoperative planning, careful dissection, and attention to detail during harvesting are key to achieving successful outcomes for patients undergoing coronary revascularization.