In situ saphenous vein bypass: prevention and management of early complications.
Since adopting the in situ, non-reversed saphenous vein technique for bypass procedures in the leg early in 1986, 50 bypasses have been performed in selected patients, primarily for limb salvage. A Mills valvulotome was used for retrograde disruption of the saphenous valves, after exposure of the whole length of vein. Significant peri-operative complications occurred in nine patients and were strongly associated with technical factors. Early graft occlusion (n = 2) and residual arteriovenous fistulae (n = 2) were revised by timely reoperation, resulting in early (30 day) patency of all but one graft. In seven patients, angioscopic visualization of the valve division process was tested as a method of ensuring complete valvulotomy, while avoiding trauma to the vein wall. Distal anastomosis to the popliteal artery above the knee or close below the knee caused a considerable degree of graft angulation, which was exacerbated by flexion of the leg, whereas anastomosis to the more distal popliteal artery or tibial vessels resulted in a favourable curvature of the graft. Lessons learned during this initial experience and aspects of technique for prevention of complications are presented.
White
G H
GH
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Williams
R A
RA
Wilson
S E
SE
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000628:therapy; D011859:Radiography; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*