Effects of Saphenous Vein Harvesting on the Leg's Venous System
Saphenous vein harvesting typically results in minimal long-term venous morbidity in the leg despite causing venous outflow obstruction, as the body develops collateral venous channels to compensate for the removed vein. 1
Immediate and Short-Term Effects
Venous outflow obstruction is present in approximately 93% of harvest limbs compared to 36% of non-harvest limbs, indicating significant initial changes to venous hemodynamics 1
Some patients experience leg swelling in the immediate post-operative period, though this is typically temporary and resolves as collateral circulation develops 2
Wound complications can occur in approximately 4.1% of cases, with major complications requiring surgical intervention in about 0.65% of patients 3
Risk factors for major leg wound complications include female gender, peripheral vascular disease, and postoperative intraaortic balloon pump use 3
Long-Term Venous Adaptations
Large, direct collateral veins (4-6mm in diameter) develop between the popliteal vein stump and profunda femoris vein in about 34% of harvest limbs 1
The remaining 66% of patients develop smaller, less direct collateral channels to the profunda femoris vein to compensate for the removed saphenous vein 1
Ambulatory venous pressure (AVP) with exercise is significantly increased in harvest limbs (60 ± 4.7 mm Hg) compared to non-harvest limbs (47.8 ± 5.2 mm Hg) 1
Venous refill time in harvest limbs (15.1 ± 1.1 seconds) is shortened compared to non-harvest limbs (22.3 ± 2.1 seconds) 1
Clinical Manifestations
Less than one-third of patients develop mild edema without skin changes (CEAP class C3) in the long term 1
Major chronic venous changes (CEAP classes C4-C6) and venous claudication are rare following saphenous vein harvest 1
Mild venous reflux may develop in approximately 11% of harvest limbs, which is associated with a higher likelihood of edema 1
The presence or absence of an intact greater saphenous vein in the other leg does not significantly affect clinical outcomes 1
Factors Affecting Venous Function
The development of collateral venous channels is the primary mechanism that preserves venous function after saphenous vein harvest 1
Low incidence of significant reflux helps maintain adequate venous return despite the loss of the saphenous vein 1
Venous function tests typically show stabilization or improvement over time, suggesting adaptive mechanisms develop to compensate for the harvested vein 1
Duplex ultrasonography is the recommended first-line imaging method to assess the venous system before and after saphenous vein harvesting 4
Modern Approaches to Minimize Complications
Endoscopic vein harvesting significantly reduces leg wound infections (0.5%) compared to open harvesting techniques (2.7%) 5
Proper preoperative assessment of the venous system using duplex ultrasound can help identify patients at higher risk for complications 4
When saphenous vein harvesting is necessary, the autologous saphenous vein remains the conduit of choice for bypass procedures due to superior patency rates 4
Careful selection of harvest sites and proper surgical technique can minimize complications in patients with risk factors for poor wound healing 3