Preoperative duplex venous mapping: A comparison of positional techniques in patients with and without atherosclerosis

John Blebea, William R. Schomaker, Giora Hod, Richard J. Fowl, Richard F. Kempczinski

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: Preoperative duplex venous mapping is the preferred modality to measure the diameter of the greater saphenous vein and its suitability as an arterial conduit for infrainguinal bypass. We wanted to determine the optimal mapping technique and maximal venous diameter in patients with and without atherosclerosis. Methods: Three groups of patients were prospectively studied: younger control subjects (n = 20), preoperative atherosclerotic patients (n = 10), and older control subjects (n = 10). All patients underwent greater saphenous vein duplex mapping in a standardized manner. Maximal internal vein diameters were measured with the subjects in the supine position in bed, in the 20 degree reversed Trendelenburg position, sitting on the edge of the bed, standing, and in the supine position with a high-thigh, low-pressure tourniquet. Measurements were taken just beyond the saphenofemoral junction, in the distal thigh, below the knee, at midcalf, and superior to the medial malleolus. Results: In younger control subjects an increasingly more erect position resulted in progressively larger measured vein diameters at all levels along the length of the leg. Both patients with atherosclerosis and older control subjects had no such increase in venous diameter with any positional change from the supine position to standing. Patients with atherosclerosis also had significantly smaller measured veins than either younger or older control subjects. A high-thigh tourniquet significantly increased vein diameters in the atherosclerotic group to the size of vein diameters in the older control group, although the absolute size differences were not large. Conclusions: The optimal position for venous mapping is with the patient in a supine position. If the internal vein diameter is below an acceptable minimum size, a high-thigh tourniquet will maximally distend the vein in patients with atherosclerosis. Vein diameter decreases with age and is less distended in patients with atherosclerosis compared with older patients without atherosclerosis.

Original languageEnglish (US)
Pages (from-to)226-234
Number of pages9
JournalJournal of Vascular Surgery
Volume20
Issue number2
DOIs
StatePublished - 1994
Externally publishedYes

Fingerprint

Atherosclerosis
Veins
Supine Position
Thigh
Tourniquets
Saphenous Vein
Head-Down Tilt
Leg
Knee
Pressure
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Preoperative duplex venous mapping : A comparison of positional techniques in patients with and without atherosclerosis. / Blebea, John; Schomaker, William R.; Hod, Giora; Fowl, Richard J.; Kempczinski, Richard F.

In: Journal of Vascular Surgery, Vol. 20, No. 2, 1994, p. 226-234.

Research output: Contribution to journalArticle

Blebea, John ; Schomaker, William R. ; Hod, Giora ; Fowl, Richard J. ; Kempczinski, Richard F. / Preoperative duplex venous mapping : A comparison of positional techniques in patients with and without atherosclerosis. In: Journal of Vascular Surgery. 1994 ; Vol. 20, No. 2. pp. 226-234.
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abstract = "Purpose: Preoperative duplex venous mapping is the preferred modality to measure the diameter of the greater saphenous vein and its suitability as an arterial conduit for infrainguinal bypass. We wanted to determine the optimal mapping technique and maximal venous diameter in patients with and without atherosclerosis. Methods: Three groups of patients were prospectively studied: younger control subjects (n = 20), preoperative atherosclerotic patients (n = 10), and older control subjects (n = 10). All patients underwent greater saphenous vein duplex mapping in a standardized manner. Maximal internal vein diameters were measured with the subjects in the supine position in bed, in the 20 degree reversed Trendelenburg position, sitting on the edge of the bed, standing, and in the supine position with a high-thigh, low-pressure tourniquet. Measurements were taken just beyond the saphenofemoral junction, in the distal thigh, below the knee, at midcalf, and superior to the medial malleolus. Results: In younger control subjects an increasingly more erect position resulted in progressively larger measured vein diameters at all levels along the length of the leg. Both patients with atherosclerosis and older control subjects had no such increase in venous diameter with any positional change from the supine position to standing. Patients with atherosclerosis also had significantly smaller measured veins than either younger or older control subjects. A high-thigh tourniquet significantly increased vein diameters in the atherosclerotic group to the size of vein diameters in the older control group, although the absolute size differences were not large. Conclusions: The optimal position for venous mapping is with the patient in a supine position. If the internal vein diameter is below an acceptable minimum size, a high-thigh tourniquet will maximally distend the vein in patients with atherosclerosis. Vein diameter decreases with age and is less distended in patients with atherosclerosis compared with older patients without atherosclerosis.",
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