Saphenous vein harvesting for coronary artery bypass grafting. Retrospective analysis of possible causes of major wound complications in patients with peripheral arterial disease

Objectives: to retrospectively evaluate the possible reasons for major woun d complications at the saphenous vein harvesting site in patients with peri pheral arterial disease (PAD). Design: retrospective study. Material and Methods: fifteen consecutive patients admitted to the vascular department for impaired healing at the saphenous vein harvesting site afte r stressful coronary bypass artery grafting (CABG) (Group A) were evaluated for medical, perioperative, laboratory and pathological factors and outcom e. Findings were compared with those in 15 matched controls followed in the outpatient clinic after CABG (Group B). Results: absence of pedal pulses in the affected leg was noted in 13 patien ts in group A and 3 patients in group B. Ankle brachial index ranged from 0 .4-0.7 in group A and 1.7-1.1 in group B; corresponding ankle pressures wer e 40-100 mmHg (mean 60 mmHg) and 80-160 mmHg (mean 110 mmHg). All patients in group A had PAD, whereas none did in group B, and all patients in group A required intervention to save the leg. Wound healing was noted in II grou p A patients; four patients underwent below-knee amputation. Conclusion: saphenous vein harvesting from limbs with severe PAD can lead t o significant morbidity, including limb loss. In patients lacking a palpabl e pedal pulse, toe recommend harvesting only the proximal saphenous vein.