title: Perioperative complications of in-situ vein bypass.
abstract: Experience with 146 in-situ vein bypass procedures for obliterative arterial disease are reviewed to determine the specific complication of the technique. Vein wall injury with the Hall valvulotome occurred in 6 patients (4%) and vein patching of a stenosed femoral vein was required in 2 patients. Residual arteriovenous fistulae occurred in 24 patients (16.5%) of whom 9 had an associated graft thrombosis distal to the fistula of which 6 were corrected by thrombectomy and fistula ligation. Perioperative thrombosis occurred in 29 grafts (20%) and was more common in the femoropopliteal group (23/80) than in the femorocrural group (6/66) (P less than 0.01, X2 = 7.55). Fourteen of the femoropopliteal and two of the femorocrural thromboses were corrected resulting in an immediate patency of 89% and 94% respectively with the cumulative patency at one year being 77.5% and 79%. Complications of the in-situ bypass technique remain despite having largely overcome the problems of valve disruption. However, until a standard method emerges careful note must be made of technique and complications when considering reports of in-situ bypass patency.
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000209:etiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications; D013927:Thrombosis / Q000209:etiology