HARVESTING & USE OF AUTOLOGOUS VEIN

Pearls

- Use reversed greater saphenous vein from uninjured extremity.
- Expose at saphenofemoral junction or anterior to medial malleolus (consistent locations).
- Be sure to mark anatomically distal end as “in-flow” assuring reversal of vein conduit. This is usually done with an ‘olive tipped’ vein cannulator that is secured in the distal end of the vein.
- Introduce 18 gauge plastic vein cannula (angiocatheter) or metallic olive tip cannula to distend the vein with heparin saline.
- Because of its versatility, resistance to infection, propensity for tissue incorporation and favorable patency rates, saphenous vein for interposition graft or patch material is favored. The greater saphenous veins may be consistently located at the saphenofemoral junction (2cm medial to the pubic tubercle) or 1-2 cm anterior to the medial malleolus. Identifying the actual saphenofemoral junction is important to confirm that the vein being exposed is truly the main channel saphenous and not an accessory branch or anterior saphenous (i.e. must follow back to main saphenofemoral junction). In the setting of trauma, the vein frequently appears in-situ as “too small” or “not adequate” due to vasoconstriction or spasm.
- Nonetheless, after confirming that the vein being exposed is the main channel saphenous, the specimen should be removed and dilated on the back table with firm infusion of heparin saline using a 14–18-gauge plastic vein cannula or the metallic olive tip cannula. Persistence and this maneuver almost always result in a markedly improved and dilated vein ready to be used for repair. Reversal of the vein must also be confirmed as venous valves will not permit flow in a retrograde fashion. Smaller sutures (7-0 prolene) are often necessary if side branches need more control than that afforded by initial harvest.