Use of Hand Held Doppler to identify venous tributaries in in situ vein arterial bypass

Background: It very important to reduce the morbidity associated with arterial bypass surgery by minimizing the length of incision used in infrainguinal bypass surgery using in situ vein as a conduit. This paper describes a quick and less invasive method of identifying the location of vein tributaries using Hand Held Doppler in arterial bypass surgery with local cut down instead of extensive exposure. Methods: The technique was used in 19 consecutive procedures. Fourteen grafts were subsequently evaluated for completeness of tributary ligation using duplex scanning. Results: A mean of 2.5 tributaries were identified per limb. Thus, there were 35 patent tributaries in our cohort of 14 patients. None was of clinical significance. Four occluded spontaneously during the period of study. Wound length was reduced by 30-60% depending on the total length of the incision. Conclusion: This technique is an effective, cheap and simple means of performing bypass surgery in high-risk patients (with significant comorbidity and a high ASA score) and also reducing inherent complications associated with the length of the incision.