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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2000 June;7(2):95-104
language: English, Italian
An ultrasonographic and histological method to evaluate the internal saphenous vein as a peripheral bypass graft
Carlesi R., Casini A., Dell’Aglio D., Milesi M. *, Gabrielli L.
From the Istituto di Chirurgia Vascolare e Angiologia * Laboratorio di Ricerche Cliniche Anatomia ed Istologia Patologica Istituti Clinici di Perfezionamento Università degli Studi, Milano, Italy
Background. To evaluate whether ultrasonographic measurement of the saphenous vein compliance, for use as a peripheral bypass, is correlated to its histological characteristics and is therefore a predictor of bypass success.
Methods. Saphenous vein compliance was evaluated preoperatively using colour Doppler ultrasonography in 12 patients suffering from chronic critical leg ischemia due to undergo femorodistal arterial reconstruction. The internal diameter of the vein was measured at the 3rd median of the thigh with an occlusion pressure of 50 mmHg and at 10-second intervals up to 120 seconds. Intraoperative biopsy followed by histological analysis was used to evaluate the thickness of the tunica intima and the walls, as well as the presence of muscle-type cells in the intima, correlating results with vein graft patency or stenosis/thrombosis.
Results. The mean increase in basal diameter at 120 sec was 0.95±0.44 mm and 23.0±10.3%; mean intimal thickness was 0.05±0.06 mm, parietal thickness was 0.73±0.31 mm and muscle type cells were present in the intima in 33.3% of cases. In saphenous veins that had developed stenosis or thrombosis compared to those which were still patent, the mean increase in basal diameter was respectively 0.57±0.15 and 1.15±0.41 mm (p=0.39) and 15.7±5.6 and 30.4±8.5% (p=0.01); intimal thickness was 0.07±0.09 and 0.04±0.03 mm (p=0.04), parietal thickness was 0.84±0.42 and 0.67±0.22 mm (p=0.07), and muscle type cells were present in the intima in 50 and 25% of cases (p=0.4).
Conclusions. Saphenous veins with greater levels of compliance and reduced intimal thickness showed a reduced incidence of vein graft stenosis or thrombosis.