2007 Abstracts: Late Incidence of Chronic Venous Insufficiency After Deep Vein Harvest

The deep veins (DV) of the thigh have proven to be versatile autogenous conduits for arterial reconstruction. Harvesting DV poses a theoretical risk of compromising venous outflow of the limb, which could predispose to chronic venous morbidity. Prior studies have characterized the immediate- and mid-term complications of DV harvest, but the sequelae of venous stasis may not be manifested for many years after DV harvest. The purpose of this study was to define the late incidence of chronic venous sufficiency and to characterize the long-term alterations in venous physiology after DV harvest.
Methods: The current study presents a case-control series of sixteen patients (28 limbs) with an interval of at least 43 months after DV harvest and six age- and gender-matched control patients (12 limbs) without DV harvest. Subjects underwent a detailed history and exam, including venous testing by air plethysmography (APG) and duplex ultrasonography. Venous insufficiency was classified according to the CEAP classification (C₀-C₆).
Results: At a mean follow-up of 70.1 ± 5.6 months (range 43-129 months), 24 of 28 limbs (85.7%) had no significant chronic venous insufficiency (CEAP C₀-C₂). Two limbs developed edema without skin changes (C₃), two limbs had edema with skin discoloration (C₄), and one limb had a history of healed venous ulceration (C₅). No limb was diagnosed with a new DVT during follow-up. The cumulative incidence of clinically significant venous morbidity (C₃-C₆) was 14.3%. APG testing (Table) confirmed relative venous outflow obstruction in 44% of limbs after DV harvest (mean outflow fraction: harvested limbs = 38.4 ± 3.9% vs. control limbs = 51.7 ± 4.3%; P = 0.04). Despite the relative outflow obstruction, the venous filling index (VFI) was normal in 90% of limbs, and the mean VFI was not significantly different between harvested and control limbs (Table). DV harvest resulted in no significant changes in calf ejection fraction (EF) in harvested limbs, compared to control limbs (Table). EF was normal in 93.3% of limbs. DV harvest also had no significant impact on the mean residual volume fraction measured in harvested limbs, compared to unharvested control limbs (Table).

*Student t test; nl = normal range of values.
Conclusions: Deep vein harvest produces few symptoms of chronic venous insufficiency, and venous ulceration is infrequent. Despite relative venous outflow obstruction, non-invasive indices of chronic venous insufficiency on APG are often normal, suggesting that the risk of developing venous ulceration is low in the majority of patients after DV harvest.