Vein and Artery Mapping

Pregunta	Respuesta
Can duplex sonography be used to confirm the presence, location, and adequacy of a vein to be used for bypass?	Yes
True or false: Saphenous veins can be used as arterial conduit for CABG or LE bypass grafts?	True
Which can be used the greater or lesser sapheous vein for CABG or LE bypass grafts?	Both
Can the cephalic and basilic veins be used for bypass grafts?	Yes
What is the pre operative assessment of vein for harvesting?	determine suitability of vein to be harvested by assessing- if the saphenous vein is present, if the saphenous vein is patent, if it is continuous, any large varicosities, and the approx size
What should the size of the Saphenous vein measure?	2.5 mm or greater
Why should you assess the deep system before vein harvesting?	The Saphenous could be feeding the deep system if compromised, and if that is so then it will not be removed.
What transducer do you use to assess the vein?	7.5-10 MHz
What is the protocol for Duplex Assessment?	Bilateral study, evaluate deep system, CFV,SFV, POP compressibility. Then scan Saphenous in transverse measuring the diameter. Check for compressibility and look for irregularites
At what levels in the Duplex assessment do you measure the Saphenous vein diameter?	Groin, Proximal/mid/distal thigh, prox/ mid/ distal calf
What are the 3 thing you should look for in determining if the GSV is a single system?	Is there an accessory saphenous vein at the saphenofemoral junction, is there a bifid system when the GSV splits into two then reconnects in the distal thigh, are there any large branch varicose veins or large tributary veins
How much will the vein diameter expand when it is arterialized?	80-100%
When is pre-op marking/ Mapping done?	Either the night before or the same day
What is the protocol for pre operative vein mapping?	Clean the area with alcohol, begin at saphenofemoral junction with vein in center or transducer and mark with pen
How does the leg need to be positioned in a vein mapping?	Dependent position
Where do you begin when you start your vein mapping?	Saphenofemoral junction
Where should the vein be in relation to the transducer?	Center
What do you do if the diameter of the GSV is less than 2.5mm?	mark with dotted line to let the surgeon aware
Should you mark larger perforators?	Yes, incisions at a perforator increases the healing time
What is another name for pre operative assessment of the radial artery?	Alans manuever
What is the Radial artery used for in harvesting?	CABG due to its long term patency
What are the advantages of harvesting radial arteries?	It is the appropriate tissue for CABG, thicker walls, less intimal hyperplasia, better availability
What are the contraindications for Radial Artery Harvesting?	iscehmic digits, Raynauds syndrome, ipsilateral athero occlusive disease in arm, sclerotic atresic or occluded artery, incomplete Palmer arch in hand
Which arm should the harvested artery come from?	Less dominant
What do you do to evaluate for Radial Artery Harvesting?	take bilateral brachial pressures to rule out subclavian artery stenosis, duplex or PPG or complete palmer arch
What do you do when performing at PPG?	place sensors on thumb or index finger and 5th digit, compress radial artery and observe and record changes. Repeat on ulnar artery
What does it mean during the PPG if the waveform flatlines during compression?	Arch is not intact
What do you do during duplex imaging of the radial artery?	identify origin of RA at the brachial artery and measure the diameter distally to the wrist
What are the average diameter of Distal RA for men? Women?	2.8mm for men, 2.4 mm for women
Should imaging be performed on both radial and ulnar arteries?	Yes, to detect stenosis, occlusion, or atresia
Besides measurement, what should you do while evaluating the radial artery?	image and doppler artery. Flow should increase with compression of ulnar artery- repeat while compressing the radial

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