Jacobs Journal of Anatomy and Physiology

Anatomical Evaluation of Great Saphenous Vein as Material for Conduit in Bypass Surgery for Critical Limb Ischemia

*Tomohisa Nagasao
Department Of Plastic And Reconstructive Surgery, Kagawa University, Kida County Miki-Cho Ikenobe , Japan

*Corresponding Author:
Tomohisa Nagasao
Department Of Plastic And Reconstructive Surgery, Kagawa University, Kida County Miki-Cho Ikenobe , Japan
Email:nagasao@med.kagawa-u.ac.jp

Published on: 2018-12-18

Abstract

The great saphenous vein (GSV) often presents partial hypoplasty. The present study elucidates the frequency of hypoplasty and the positional tendency with which GSVs present hypoplasty. GSVs taken from 41 lower limbs of embalmed cadavers were divided into four types according to the positions of their hypoplastic parts. They are, Type 1: GSVs that don’t present hypoplasty; Type 2a: GSVs in which hypoplasty is located in the upper thigh; Type 2b: GSVs in which hypoplasty is located in the lower thigh; Type 2c: GSVs in which hypoplasty extends to both the upper thigh and lower thigh. The numbers of the specimens of these anatomical types were counted. For types presenting with partial hypoplasty, length of the hypoplastic parts and the distances between the hypoplastic parts and the knee were evaluated. The anatomical types occurred in descending frequency as follows: Type 2b (65.8%), Type 1 (24.3%), Type 2a (7.3%), and Type 2c (2.4%). The average length of hypoplastic parts was 10±3.3SD cm for Type 2b and 5.8±2.3SD cm for Type 2a. The average distance of the hypoplastic parts from the knee was 10.0±5.2SD cm for Type 2b and 10.5±6.5SD cm for Type 2a. A majority (75.6%) of GSVs present partial hypoplasty. For successful performance of bypass surgery for critically ischemic limbs, care should be taken not to include hypoplastic parts in conduits. The findings of the present study are useful to avoid hypoplastic parts when creating bypass conduits.

Keywords

Critical Limb Ischemia, Bypass, Graft, Great Saphenous Vein, Conduit, Anatomy, Cadaver

Introduction

The current prevalence of high-calorie diets and sedentary lifestyles is accompanied by increasing numbers of patients with diabetes mellitus, and accordingly, increasing numbers of patients develop critical limb ischemia (CLI). CLI presents serious symptoms, such as ambulatory difficulty, pain, and infection of the lower limbs, which considerably impairs patients’ quality of life. Bypass surgery is conducted for stenotic parts of affected arteries to relieve patients of these symptoms and to increase blood flow to lower limbs. In performing bypass surgery, the great saphenous vein (GSV) is often harvested to be used to form conduits for bypasses. The GSV branches out from the femoral vein at the sapheno-femoral junction (SFJ), passes by the medial epicondyle of the femoral bone (MEF), and ends at the medial malleolus of the tibia (MMT) (see Figure 1). Variations in the anatomical structure of GSVs have been observed. In some persons, GSVs present partial hypoplasty during the course from the SFJ to the MMT. If the hypoplastic parts are included in a conduit, the conduit develops thrombosis, and the treatment fails. Therefore, to ensure optimal outcomes in bypass surgeries for CLI, hypoplastic parts should not be included in the conduit. To avoid the inclusion of hypoplastic parts in bypass conduits, it is essential to understand the locations within the GSV at which it is likely to present hypoplasty.