Orhan OYAR, Ahmet YEŞİLDAĞ, Turhan YAVUZ, Erdoğan İBRİŞİM, Ahmet ÖCAL, Ali KUTSAL

Modifiye safen ven insizyonunun bacak ödemi ve venöz fonksiyonlar üzerine etkisi

Amaç: Bu çalışmada klasik kesi ve modifiye kesi ile safen ven greft (SVG) hazırlanması sonrası bacak ödemi ve venöz fonksiyon arasnıda fark olup olmadığı araştırıldı. Materyal ve Metod: Grup A (n = 20) modifiye kesi ile SVG hazırlanan, Grup B ise (n = 19) klasik kesi ile SVG hazırlanan olgulardan oluşmaktaydı. Grup A'da SVG iç malleolün 5 cm üstünden başlayan kesi ile SVG hazırlandı. Grup B'de ise SVG iç malleol üstünden başlayan klasik kesi ile hazırlandı. Bulgular: Grup A yaş ortalaması 65.2 ± 3.7 olan 11'i erkek, 9'u kadın 20 olgudan, Grup B ise yaş ortalaması 64.6 ± 3.45 olan 13'ü erkek, 6'ı kadın 19 olgudan oluşmaktaydı. Postoperatif 1. hafta, 1. ay ve 3. ayda Leg-O-Meter ile yapılan bacak çap ölçümlerinde Grup A'da çap artışı Grup B'e göre daha azdı. Sonuç: Modifiye safren ven kesisi pratiktir, deneyim gerektirmez. Bu metodla SVG hazırlanması sonrası bacak ödemi daha azdır, venöz fonksiyonlarda da değişiklik olmaz.

Modified versus traditional incision for long saphenous vein harvesting and their compared effect on leg swelling and venous function

Background: This prospective, randomized trial compared edema and venous functions associated with saphenous vein (SV) harvested using an modified incision versus a traditional longitudinal incision. Methods: Patients in Group A (n = 20) underwent saphenous vein harvesting using a modified incision. Patients in Group B (n = 19) had their greater SV harvested using an traditional technique. In Group A, after usual preperation of the leg, a 2 cm transvers skin incision 5 cm above the medial ankle and length was dependent upon the number of vein grafts requered.In Group B, after usual preperation of the leg, the patients had their greater SV harvested by physician assistant using traditional longitudinal incision without skin bridges. Results: In Group A, the mean age was 65.2 ± 3.7, 11 (60%) patients were male, 9 (40%) patients were female. In group B, the mean age was 64.6 ± 3.45 years, 13 (66%) patients were male and 6(34%) patients were females. In measurements performed at postoperative first week, first month and third month, increase in leg circumference was less in Group A than in Group B . Conclusion: In conclusion, modified incision for saphenous vein harvesting is practical and can be performed even by unexperienced surgeons. When SV harvesting by this method, leg edema is seen with a lower frequency and there is no change in venous functions.

PDF

___

1. Chukwuemekai A, Lindsay J. Modified incision for long saphenous vein Harvest. Ann Thorac Surg 1998;66:279.
2. Kan CD, Luo CY, Yang YJ. Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients. J Card Surg 1999;14:157-62.
3. Lehmann A, Lang J,Weisse U, Boldt J. Pneumoperitoneum secondary to endoscopic harvest of saphenous vein graft. Ann Thorac Surg 2000;69:1937-8.
4. Tevaearai HT, Mueller XM, Von Segesser LK. Minimally invasive harvest of the saphenous vein for coronary artery bypass grafting. Ann Thorac Surg 1997;63:119-21.
5. L’Ecuyer PB, Murphy D, Little JR, et al. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis 1996;22:424-9.
6. Utley JR, Thomason ME, Wallace DJ, et al. Preoperative correlated of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg 1989;98:147-9.
7. Allen KB, Griffith GL, Heimansohn DA, et al. Endoscopic versus traditional saphenous vein harvesting: A prospective, randomized trial. Ann Thorac Surg 1998;66:26-32.
8. Dimitri WR,West IE,Williams BT. A quick and atraumatic method of autologous vein harvesting using the subcutaneous extraluminal dissector. J Cardiovasc Surg 1987;28:103-11.
9. Allen KB, Shaar CJ. Endoscobic saphenous vein harvesting. Ann Thorac Surg 1997;64:265-6.
10. Terada Y, Fukuda S, Tohda E, et al. Venous function and delayed leg swelling following saphenectomy in coronary artery bypass grafting. Jpn J Thorac Cardiovasc Surg 1999;47:559-62.
11. Pagni S, Ulfe EA, Montgomery WD, et al. Clinical experience with the video-assisted saphenectomy procedure for coronary bypass operatios. Ann Thorac Surg 1998;66:162-3.
12. Gnepp DR. Lymphatics. In: Stanb NC, Taylor AE, eds. Edema. New York: Raven Press, 1984:266-9.
13. Zuccarelli F, Abenhaim L, Berard A. Reliability study of the Leg-O-Meter in patients suffering from venous insufficiency of the lower limbs. Phlebology 1995;1:295.
14. Perrin M, Guex JJ. Edema and leg volume: Methods of assessment. Angiology 2000;51:615-6.
15. Berard A, Kurz X, Zuccarelli F, et al. Validity of the Leg- O-Meter, an instrument to measure leg circumference. Angiology 2002;53:21-8.
16. Lunt MJ. Review of duplex and colour Doppler imaging of lower-limb arteries and veins. J Tissue Viability 1999;9:45-55.
17. Bendayan P, Boccalon H. Cost-effectiveness of noninvasive tests including duplex scanning for diagnosis of deep venous thrombosis. Vasa 1991;20:348-53.
18. Sumner D. Strain-gauge plethysmography. In: Bernstein EF ed. Noninvasive Diagnostic Techniques in Vascular Disease. St. Louis: CV Mosby, 1985:746.