The Journal is included in Russian and International Library and Abstract Databases
Russain Science Index (Russia)
EBSCO
DOI Registration Agency (USA)

The lower limb after coronary artery bypass surgery

DOI: https://doi.org/10.29296/25877305-2019-06-13
Issue: 
6
Year: 
2019

Yu. Vechersky, MD; D. Manvelyan; V. Zatolokin, Candidate of Medical Sciences; K. Zavadovsky, MD; S. Sazonova, Candidate of Medical Sciences; V. Usov, MD; V. Shipulin, MD Research Institute of Cardiology, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk

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

Keywords: 
coronary artery bypass surgery
endoscopic vein harvest
lymphatic outflow
lymphoscintigraphy
MRI



References: 
  1. Athanasiou T., Aziz O., Skapinakis P. et al. Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting // Ann. Thorac. Surg. – 2003; 76 (6): 2141–6.
  2. Athanasiou T., Aziz O., Al-Ruzzeh S. et al. Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis // Eur. J. Cardiothorac. Surg. – 2004; 26 (5): 1015–26. DOI: 10.1016/j.ejcts.2004.07.013/
  3. Lavrenjuk O.V., Chernjavskij A.M., Volkov A.M. i dr. Sostojanie limfaticheskogo rusla nizhnih konechnostej posle otkrytogo i endoskopicheskogo vydelenija bol'shoj podkozhnoj veny pri operatsii koronarnogo shuntirovanija // Angiologija i sosudistaja hirurgija. – 2013; 19 (3): 46–51.
  4. Lishmanov Ju.B., Chernov V.I., Balabanova A.A. i dr. Natsional'noe rukovodstvo po radionuklidnoj diagnostike: v 2 t. T. 2 / Tomsk: STT, 2010; 246–51 [Lishmanov Yu.B., Chernov V.I., Balabanova A.A. i dr. Natsional’noe rukovodstvo po radionuklidnoi diagnostike: v 2 t. T. 2 / Tomsk: STT, 2010; 246–51 (in Russ.)].
  5. Dmitrieva L.A., Amosov V.I., Katsev V.M. i dr. Limfostsintigrafija nizhnih konechnostej: diagnosticheskie vozmozhnosti metody // Regionarnoe krovoobraschenie i mikrotsirkuljatsija. – 2002; 1 (3): 48–52 [Dmitrieva L.A., Amosov V.I., Katsev V.M. i dr. Limfostsintigrafiya nizhnikh konechnostei: diagnosticheskie vozmozhnosti metody // Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya. – 2002; 1 (3): 48–52 (in Russ.)].
  6. Vecherskij Ju.Ju., Zatolokin V.V., Petlin K.A. i dr. Novyj metod endoskopicheskogo vydelenija bol'shoj podkozhnoj veny v otkrytoj sisteme // Angiologija i sosudistaja hirurgija. – 2017; 23 (2): 131–6 [Vechersky Yu.Yu., Zatolokin V.V., Petlin K.A. et al. A new method of endoscopic harvesting of the great saphenous vein in an open system // Angiologiya i sosudistaya khirurgiya. – 2017; 23 (2): 131–6 (in Russ.)].
  7. Souza D., Dashwood M., Tsui J. et al. Improved patency in vein grafts harvested with surrounding tissue: results of a randomizedstudy using three harvesting techniques // Ann. Thorac. Surg. – 2002; 73 (4): 1189–95.
  8. Chen L., Bouley D., Yuh E. et al. Study of focused ultrasound tissue damage using MRI and histology // J. Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. – 1999; 10 (2): 146–53.
  9. Loerakker S., Manders E., Strijkers G. et al. The effects of deformation, ischemia, and reperfusion on the development of muscle damage during prolonged loading // Am. J. Physiol.-Heart Circ. Physiol. – 2011; 111 (4): 1168–77. DOI: 10.1152/japplphysiol.00389.2011.
  10. Raja S., Sarang Z. Endoscopic vein harvesting: technique, outcomes, concerns & controversies // J. Thorac. Dis. – 2013; 5 (Suppl. 6): S630–7. DOI: 10.3978/j.issn.2072-1439.2013.10.01.
  11. Bai P., Wang Y., Chen S. et al. Application of EndoscopicVein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting // Curr. Med. Sci. – 2018; 38 (4): 691–6. DOI: 10.1007/s11596-018-1932-z.
  12. Graham S., Chen L., Leitch M.et al. Quantifying tissue damage due to focused ultrasound heating observed by MRI // Magn. Reson. Med. – 1999; 41 (2): 321–8.
  13. Brothers T., Tagge D., Stutley J. et al Magnetic resonance imaging differentiates between necrotizing and non-necrotizingfasciitis of the lower extremity // J. Am. Coll. Surg. – 1998; 187 (4): 416–21.
  14. Young A., McNaught C. The physiology of wound healing // Surgery (Oxford). – 2011; 29 (10): 475–9. DOI: 10.1016/j.mpsur.2011.06.011.
  15. Stekelenburg A., Oomens C., Strijkers G. et al. Compression-induced deep tissue injury examined with magnetic resonance imagingand histology // J. Appl. Physiol. (1985). – 2006; 100 (6): 1946–54.
  16. Schacht V., Luedemann W., Abels C. et al. Anatomy of the subcutaneous lymph vascular network of the human leg in relation to the greatsaphenous vein // Anat. Rec. (Hoboken). – 2009; 292 (1): 87–93. DOI: 10.1002/ar.20765.
  17. Belczak C., de Godoy J., Cruz Júnior A. et al. Lymphoscintigraphic findings: delayed oedema after great saphenous veinharvesting // Phlebology. – 2011; 26 (5): 185–90. DOI: 10.1258/phleb.2010.010071.