Femoropopliteal in situ saphenous vein bypass: technical aspects and factors determining patency.
The results and the factors influencing long-term patency rates in two technical variations of femoropopliteal "in situ" saphenous vein bypass procedures were evaluated retrospectively. Technique I (n = 33) consisted of a limited approach to the saphenous vein, destruction of the valves with a Cartier stripper and no tributary ligation. Technique II (n = 55) included complete exposure of the saphenous vein valvular destruction using Hall's stripper and ligation of all tributaries. Early thrombosis was observed in 21% and 3.6% of cases in techniques I and II, respectively. The frequency of local complications was identical in both techniques (18%). Overall actuarial primary patency at 4 years was 70%. Secondary patency (including patency following reoperations for graft failure) was 88% overall, 78.5% in technique I and 95% in technique II (p less than 0.05). The site of the distal anastomosis significantly influenced the four year cumulative patency rate (upper popliteal - 100%, lower popliteal - 93.6%, tibioperoneal vessels - 70.5%, p less than 0.05), whereas the number of patent leg vessels, the clinical stage of disease and the site of the proximal anastomosis (common femoral or superficial femoral artery) did not. Results obtained with the in situ saphenous vein bypass using technique II were better than with technique I. Close follow-up and preventive reoperations clearly enhanced patency rates. The site of distal anastomosis significantly affected long-term results.
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D014654:Vascular Patency