title: In situ saphenous vein arterial bypass for infrainguinal revascularization: initial experience using an open technique.
abstract: The authors describe their initial experience with the use of the in situ saphenous vein arterial by-pass technique for infrainguinal revascularization. From December 1986 to August 1989, we performed 101 in situ saphenous vein arterial by-passes. From these 101 by-pass, 18 composite or partial in situ vein by-passes (in situ + reversed vein) and 2 extra-anatomical sequencial by-passes (one axillofemoral and one cross-over femorofemoral proximal by-passes extended by in situ saphenous vein femoropopliteal arterial by-passes) were withdrawn from the statistics, with the purpose of analysing the natural evolution of the in situ vein arterial by-pass without the insertion of reversed vein segments and/or the influence of artificial grafts to improve arterial inflow. Therefore only 81 in situ by-pass cases will be analysed in the present paper. From these 81 cases, 44 (54.3%) were performed in diabetic patients and limb salvage was the indication for by-pass in 63 (81%). The saphenous vein valves were rendered incompetent utilising the retrograde Mills-Leather valvulotome and exposing the greater saphenous vein with a continuous incision. In the 81 cases, wound complications occurred in 18 limbs (22%) and operative mortality (30 days) was 6.1%. Primary cumulative patency rate of the 81 cases was 77% and secondary cumulative patency rate was 80%, at the end of the analysed period. The open technique, using a retrograde valvulotome and exposing the entire conduit of the greater saphenous vein, became our preferred technique for infrainguinal revascularization.
authors.affiliation: Vascular Service, Jacarepaguá General Hospital, National Institute of Social Welfare, Rio de Janeiro, Brazil.
authors.forename: A V
authors.initials: AV
authors.lastname: de Mello
authors.forename: C M
authors.initials: CM
authors.lastname: Santos
authors.forename: J L
authors.initials: JL
authors.lastname: Silva
authors.forename: M T
authors.initials: MT
authors.lastname: Souza
authors.forename: M A
authors.initials: MA
authors.lastname: Portilho
authors.forename: A V
authors.initials: AV
authors.lastname: Guimarães
authors.forename: R G
authors.initials: RG
authors.lastname: Freitas
authors.forename: J W
authors.initials: JW
authors.lastname: Silvério
mesh_terms: D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery*; D016909:Tibial Arteries / Q000601:surgery; D014654:Vascular Patency / Q000502:physiology