The lower limb after coronary artery bypass surgery

The original procedure for endoscopic harvest (EH) of the great saphenous vein (GSV) in the flap with the surrounding tissues has contributed to a significant reduction in the frequency of wound complications. However, harvesting in the flap is very traumatic for the lower extremities, although a direct quantitative assessment of wound complications has previously been carried out. Of interest was also the impact of the new procedure for GSV EH on lymphatic outflow, since such publications are not sufficient and the results are ambiguous. Objective: to comparatively assess lymphatic drainage function and to quantify the volume and extent of soft- tissue injury of the lower extremities after GSV EH. For this, before and after coronary bypass surgery, the patients underwent radionuclide lymphoscintigraphy of the lower limb (in 16 patients in the open harvest (OH) group and in 14 after EH) and magnetic resonance imaging of the lower limbs (in 21 patients in the OH group and in 23 in the EH group). Instrumental examination was complemented by measurements of changes in the lower limb circumference in order to verify lymphostatic edema. The scintigraphic signs of impaired lymphatic outflow were observed in 62.5% of cases in OH and in 42.86% in the use of the original endoscopic procedure. Lymphatic edema occurred in 12.17% of cases after EH and in 45.28% after traditional harvest (p<0.0001). In addition, the EH group demonstrated the lesser extent of the injury zone (8.96±2.87 and 11.2±3.1 cm, respectively; p<0.05) and the smaller volume of edematous tissue (1.50±0.95 and 5.8±2.6 cm3; p<0.05).

coronary artery bypass surgery, endoscopic vein harvest, lymphatic outflow, lymphoscintigraphy, MRI