Selection of saphenous vein conduit in varicose vein disease

Background. Limbs with varicose veins are difficult to assess as a source of saphenous vein conduit. Anatomic, histologic, and ultrasound studies demonstrate two types of longitudinal veins in the lower extremities. The great saphenous vein is deep to the saphenous fascia. Accessory saphenous veins are superficial to this layer and have thin walls with diminished muscle cells and elastic fiber. Accessory saphenous veins dilate and form varicosities. Segments of great saphenous veins are often suitable as coronary conduits. No studies have assessed the suitability of saphenous veins as coronary artery conduits in patients with varicose vein disease. Methods. Intraoperative high-resolution ultrasound studies were performed in coronary artery bypass graft procedures to assess lower extremity venous morphology in limbs of 77 patients without known venous disease, in 19 limbs with venous telangiectases, and in 23 limbs with varicose veins. Results. Dilated great saphenous vein segments were identified in 6% of normal limb venous segments compared with 21% of segments in limbs with telangiectases (p=0.027) and 22% of segments in limbs with varicosities (p=0.012). The incidence of absent or hypoplastic great saphenous vein segments is increased in limbs with varicosities (35%) compared with normal limbs (21%; p=0.032). In the calf, at least one great saphenous vein segment suitable for coronary artery bypass grafting is present in 70% of limbs with varicosities and in 89% of limbs with telangiectases. Conclusions. Ultrasound studies document that varicose veins are limited to accessory saphenous veins. Great saphenous vein conduits, identified by ultrasonography, are available in limbs with varicose vein disease.