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How will ablation treatment affect my saphenous vein if I need heart surgery?

My doctor suspects I have a leaky saphenous vein. From what I understand, ablation treatment can fix this leakage. However, my father had to have heart surgery in his 50s and I'm aware that I might have the same problems down the road. Will ablation ruin my saphenous vein and make heart surgery more difficult for me in the future? Are there other veins that can be used for heart surgery?


Doctors Answers (7)

The Greater Saphenous Vein (GSV) is the largest superficial vein in the legs and extends from the groin down the inner thigh to the ankle. This vein can be harvested and used to bypass or jump across a single blockage or several blockage points in a coronary artery by the cardiac surgeon. The vein is larger than the artery so it can tolerate the pressure and as it is now exposed to rapidly moving, oxygenated blood with a more alkaline pH and low CO2 content, these changes in conditions induce the vein to adapt and over time as the walls thicken, it transforms from a vein into an open, thick walled normal artery to carry the coronary blood through the heart. In your case, possibly needing the GSV for some future surgery, the answer would be to get a detailed venous duplex ultrasound evaluation to determine the vein diameter, degree of branching and severity of reflux. If the vein is greatly enlarged (5mm is the upper end of normal for the GSV diameter in an adult), then the varicose vein would be useless to the cardiologist for grafting and treatment is recommended. A normal GSV obviously should not be treated, and determination of when the vein is no longer beneficial can be determined by a vein specialist or your cardiologist.

If the valves in your saphenous veins are not working and if the veins are enlarged, they would not make a good bypass graft for heart surgery. Once the vein is ablated it is shut down and will absorb and will not be able to be used for a heart bypass. There are other vessels/arteries that are used for a heart bypass when the saphenous veins can not be used (radial, mammary). I suggest if your saphenous veins are causing a lot of symptoms that are unresponsive to conservative treatment, you should proceed with treatment.

It is my understanding that if your saphenous is incompetent, it will not be used for CABG. There are alternate vessels that can be used.

If the great saphenous vein truly is incompetent and needs to be ablated, it is of little value as a bypass graft for heart surgery. Many cardiac surgeons prefer to use the radial artery from the forearm or the internal mammary artery from within the chest for cardiac bypasss graft material.

Ablation does indeed close off the vein and makes in unusable as a conduit for bypass grafting. Vein surgery/ablation should be reserved for severe complications of vein disease, such as ulcers on the leg.

Saphenous reflux is most commonly seen in the greater (or long) saphenous vein. This was commonly used for cardiac bypass surgery some years ago as it was easy to harvest. However, most heat artery blockages are now treated with stents. In some patients with more blocked heart arteries, grafted arteries are used, as they are more durable. These can be internal mammary or radial arteries from the lower arm. If you have symptomatic saphenous reflux with painful varicose veins it is advisable to have the laser ablation. The vein will not be usable as it will be sealed. If you have no painful varicose veins or leg pain you can wait, but we would advise wearing some sort of compression hose even in the knee length to improve your circulation.

It depends in what segment you have reflux, how large the vein is and how bad your venous disease is. Most cardiothoracic surgeons cannot use veins over four mm for cardiac surgery. Most vein procedures are done in veins over five mm in diameter. We try to preserve a calf segment of the GSV which could later be used for a bypass if need be. There are other veins and arteries (i.e. mammary arteries, radial arteries and other venous conduits ) that can be used as bypass conduits besides the GSV. If you have significant venous insufficiency then it may be worth treating this vein even if you have coronary artery disease in your family, as this causes its own morbidity. I would see a vascular physician and discuss your concerns with them.

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