Question

A patient presents for a bilateral lower extremity mapping of the great saphenous vein. On the right leg, there is an incision that runs from the upper thigh to the mid calf. The patient explains that he underwent a coronary artery bypass graft several years earlier, and the surgeons used vein from his right leg. Do you alter your planned mapping procedure? Why or why not? If so, how?

Answer 1

The mapping procedure for the great saphenous vein should indeed be altered due to the prior harvesting of the great saphenous vein in the patient's right leg for a bypass graft. Only the intact left leg should be fully mapped, while the right leg should consider the altered venous anatomy due to the previous surgery.

Step-by-step explanation:

Given the patient's history of a prior coronary artery bypass graft using the great saphenous vein from the right leg, the planned bilateral lower extremity mapping of the great saphenous vein should be altered. This is because the section of the great saphenous vein that was harvested for the bypass is no longer available for physiological functions or additional surgical interventions in the right leg. Therefore, mapping the right leg would not provide accurate data about the function and structure of the great saphenous vein in its entirety.

In such a scenario, modifications to the mapping should be made, focusing on the left leg where the integrity of the great saphenous vein is assumed to be intact. On the right leg, mapping should be adjusted to bypass the incised section and evaluate the residual venous system, which may include the remaining segments of the great saphenous vein, deep femoral vein, and other collateral veins. Anastomoses between veins mean that while removal of the great saphenous vein can affect circulation, the remaining venous network can often compensate to a certain degree.