Saphenous neuralgia after coronary artery bypass grafting

Objective: To determine the incidence, extent and site of saphenous neuralg ia (anaesthesia, hyperaesthesia and pain) in the lower Limb after harvestin g of great saphenous vein (GSV) for coronary artery bypass grafting (CABG). Methods: Thirty-two consecutive patients (39 lower limbs) aged 58 +/- 16 y ears undergoing CABG were prospectively reviewed. All patients were assesse d pre-operatively to establish the presence of normal sensation, then at 3 days, 6 weeks and 20 +/- 4 months post-operatively for symptoms or signs of saphenous neuralgia. The data were recorded on serial diagrammatic represe ntations, and the area of sensory loss for each site was recorded at each r eview. The decrease in areas of sensory loss over time was investigated wit h statistical analysis. Results: Thirty-five (90%) of the lower limbs exami ned showed some degree of anaesthesia at 3 days with 23 (72%) still symptom atic at a mean follow up of 20 months. Hyperaesthesia and pain were infrequ ently noted. Anaesthesia was generally confined to three main areas, which were denoted sites A, B and C for descriptive purposes. The mean area of se nsory loss in the lower limb at 3 days post-surgery was 53.4 cm(2), for an incision of mean length 42 +/- 22 cm from the medial malleolus. This area r educed to 31.7 cm(2) by 20 months, and the decrease in area over time for e ach site was found to be statistically significant using analysis of varian ce for repeated measures and the Freidman-Rubin test. Conclusions: This stu dy demonstrates that saphenous neuralgia after harvest of GSV for CABG is c ommon. The main symptom is anaesthesia and certain areas may persist for so me considerable time post-operatively. (C) 1999 Published by Elsevier Scien ce B.V. All rights reserved.