Abstract
Saphenous veins (SVs) are frequently employed as bypass grafts. The SV graft failure is predominantly seen at the valve site. Avoiding valves during vein harvest would help reduce graft failure. We endeavored to detect SV valves, tributaries, and vessel size employing upright computed tomography (CT) for the raw cadaver venous samples and in healthy volunteers. Five cadaver legs were scanned. Anatomical analysis showed 3.0 (IQR: 2.0–3.0) valves and 13.50 (IQR: 10.00–16.25) tributaries. The upright CT completely detected, compared to 2.0 (IQR: 1.5–2.5, p = 0.06) valves and 9.5 (IQR: 7.5–13.0, p = 0.13) tributaries by supine CT. From a total of 190 volunteers, 138 (men:75, women:63) were included. The number of valves from the SF junction to 35 cm were significantly higher in upright CT than in supine CT bilaterally [upright vs. supine, Right: 4 (IQR: 3–5) vs. 2 (IQR:1–2), p < 0.0001, Left: 4 (IQR: 3–5) vs. 2 (IQR: 1–2), p < 0.0001]. The number of tributaries and vessel areas per leg were also higher for upright compared with supine CT. Upright CT enables non-invasive detection of SV valves, tributaries, and vessel size. Although not tested here, it is expected that upright CT may potentially improve graft assessment for bypass surgery.
Highlights
Saphenous veins (SVs) are frequently employed as bypass grafts
This study showed that the saphenous vein (SV) valves were clearly visualized in the standing position utilizing upright computed tomography (CT) both in cadaveric legs and in-vivo study of healthy volunteers
Upright CT detected a larger number of valves and tributaries as well as a larger size of vessel area compared with supine CT
Summary
Saphenous veins (SVs) are frequently employed as bypass grafts. The SV graft failure is predominantly seen at the valve site. We endeavored to detect SV valves, tributaries, and vessel size employing upright computed tomography (CT) for the raw cadaver venous samples and in healthy volunteers. The number of tributaries and vessel areas per leg were higher for upright compared with supine CT. It has been proposed that non-inclusion of venous samples with valve sites may reduce SV graft failure. This concept has led to the development of v alvulotomy[8]; this approach did not improve p rognosis[9]. Employing the upright CT, we aimed to detect SV valves, tributaries, and venous areas and compare them with those obtained using standard supine CT imaging
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