Risk Factors for Chronic Saphenous Neuralgia Following Coronary Artery Bypass Graft Surgery Utilizing Saphenous Vein Grafts

Sameh M Hakim, Samer N Narouze
Pain Practice: the Official Journal of World Institute of Pain 2015, 15 (8): 720-9

OBJECTIVES: The aim of this trial was to determine risk factors for chronic saphenous neuralgia (SN) following harvesting of the great saphenous vein (GSV) for coronary artery bypass graft (CABG) surgery.

METHODS: In a prospective observational trial, 526 patients with no history of chronic painful disorders or surgery in the lower limbs were followed up for 13 weeks after undergoing CABG surgery in which GSV grafts were used. The primary outcome measure was persistence of clinically significant pain of neuropathic type in the territory supplied by the saphenous nerve beyond 12 weeks after surgery.

RESULTS: Eighty-one (15.4%) patients consistently had probable neuropathic pain of clinically significant severity throughout the follow-up period and were labeled as suffering from chronic SN. Multivariable binary logistic regression analysis showed that younger age (OR, 0.92; 95% CI, 0.88-0.95; P-value, < 0.0001), female gender (OR, 2.28; 95% CI, 1.21-4.29; P-value, 0.011), higher body mass index (OR, 1.25; 95% CI, 1.17-1.35; P-value, < 0.0001), diabetes mellitus (OR, 2.13; 95% CI, 1.13-4.01; P-value, 0.020), distal-to-proximal dissection of the GSV (OR, 7.28; 95% CI, 3.62-14.66; P-value, < 0.0001), and closure of the leg wound in two layers (OR, 3.28; 95% CI, 1.81-5.95; P-value, 0.0001) were independent risk factors for chronic SN.

CONCLUSIONS: Chronic SN after CABG surgery utilizing GSV grafts is not uncommon. Risk factors identified in this trial are younger age, female gender, higher body mass index, diabetes mellitus, distal-to-proximal dissection of the GSV, and closure of the leg wound in two layers.

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