Scan Map And Bridge - 'the Poor Mans Endoscopic Vein Harvesting Method'
Yanxue Li, Louise Parry, Catherine Sudarshan.
Papworth Hospital NHS Foundation Trust, Papworth Everard, United Kingdom.
OBJECTIVE: The purpose of these studies is to demonstrate a technique which reduces leg wound incisions during saphenous vein harvesting, for patients undergoing Coronary Aryery Bypass Surgery. During the challenging financial climate and in the absence of Endoscopic Vein Harvesting, Scan, Map and Bridge could be considered a cost effective option in the future.
METHODS: Two prospective studies undertaken; a pilot and comparative study. Pilot study collected data on 87 patients scanned at a single institution over 1 year. Demographics, site of scan, time taken, change of strategy or benefit to procedure were noted. Comparative study; data collected on 172 patients in 2 cohorts: mapped and non mapped vein.Incision length, length of vein harvested and length of unusable vein were noted. Both studies were undertaken by the Surgical Care Practitioner Team.
RESULTS: Pilot study showed information gained by vein mapping resulted in a change of strategy or aided the procedure in 63% of patients and in one instance even resulted in the patient not moving forward to a futile exploration of conduit. Similarly a patient considered to have no suitable conduit; after scanning, usable vein identified and surgery performed. Comparative study showed 40% (69) of patients were mapped, 36% (25) of which resulted in a change in strategy including change of leg, aided bridging, change of radial artery harvest to vein harvest and confirmed best site.18% (31) patients had unusable segments of vein: of which 42% (13) were mapped and 58% (18) were unmapped.
CONCLUSIONS: Ultrasound vein mapping is an effective way of assessing the anatomy and quality of conduit in patients undergoing coronary artery bypass surgery. It also aids bridging as tributaries can be identified and marked in order to appropriately place incisions facilitating ease of dissection and tunnelling of the vein thus producing a less invasive technique than open vein harvesting.
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