title: Unsuspected preexisting saphenous vein disease: an unrecognized cause of vein bypass failure.
abstract: Our prior anecdotal experience with unsuspected preexisting saphenous vein disease prompted us to study its incidence, its relation to graft failure, and to identify techniques for its detection. Thick-walled, postphlebitic sclerotic occluded, postphlebitic sclerotic recanalized, calcified, and varicose vein lesions were detected in 63 (12%) of 513 infrainguinal vein bypasses. In 13 (2% to 5%) cases, severe saphenous vein disease precluded use of the vein. In the remaining 50 cases, the entire vein or a portion thereof, with minimal or unsuspected disease, was used for bypass. Early graft failures occurred in 10 (20%) of the 50 cases. The cumulative primary patency rate at 30 months for bypasses performed with diseased veins was 32%. This was significantly less than the 73% cumulative primary patency rate for bypasses with veins without detectable disease (p less than or equal to 0.001). Retrospective evaluation of preoperative duplex ultrasonography (n = 21) originally used to evaluate saphenous vein length and diameter correctly identified thick-walled, occluded, calcified, and varicose veins in 62% of cases. Intraoperative methods of vein evaluation included inspection, palpation, irrigation, catheter or valvulotome insertion to identify obstruction, and intraoperative arteriography. Histologic examination of diseased veins demonstrated a spectrum of disease with thickening of the intima and media, vein wall calcification, and luminal recanalization. We conclude that (1) unsuspected preexisting saphenous vein disease occurs in approximately 12% of cases and results in both early and late graft failures; (2) detection, in some cases, is possible with duplex ultrasonography and intraoperative techniques; and (3) diseased veins that are recanalized, calcified, or thick-walled should not be used if an alternative vein is available.
authors.affiliation: Division of Vascular Surgery, Montefiore Medical Center, New York, NY 10467.
authors.forename: T F
authors.initials: TF
authors.lastname: Panetta
authors.forename: M L
authors.initials: ML
authors.lastname: Marin
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.forename: J
authors.initials: J
authors.lastname: Goldsmith
authors.forename: R E
authors.initials: RE
authors.lastname: Gordon
authors.forename: A M
authors.initials: AM
authors.lastname: Jones
authors.forename: M L
authors.initials: ML
authors.lastname: Schwartz
authors.forename: S K
authors.initials: SK
authors.lastname: Gupta
authors.forename: K R
authors.initials: KR
authors.lastname: Wengerter
mesh_terms: D016009:Chi-Square Distribution; D006119:Groin; D006801:Humans; D015993:Life Tables; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation*; D014463:Ultrasonography / Q000379:methods; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000473:pathology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D014654:Vascular Patency