The myth of the in situ graft: superiority in infrainguinal bypass surgery?
OBJECTIVE
to compare the clinical outcome of in situ and reversed bypass grafting.


METHODS
multicentre, prospective, non-randomised study.


METHODS
five-hundred patients with an in situ graft and 955 patients with a reversed graft were compared regarding graft occlusion, the need for graft revision, and limb salvage.


RESULTS
two-year assisted primary patency of femoropopliteal bypass procedures was 82% for in situ and 82% for reversed grafts. The corresponding hazard ratio (HR) for occlusion was 1.27 (95% CI 0. 91-1.77). The 2-year assisted primary patency of femorocrural bypass procedures was 69% for in situ vs. 70% for reversed grafts. The corresponding HR was 1.13 (95% CI 0.73-1.75). Adjustment for relevant baseline variables did not change the results. More reinterventions were needed to maintain integrity and patency of the in situ graft especially in crural bypasses. No differences in limb salvage rates were seen.


CONCLUSIONS
reversed and in situ vein grafts have similar patency and limb salvage rates for both femoropopliteal and femorocrural bypass procedures. The in situ graft needs more secondary interventions.
Lawson
J A
JA
University Hospital Utrecht, Department of Vascular Surgery, Utrecht, 3508 GA, PO Box 85500, The Netherlands.
Tangelder
M J
MJ
Algra
A
A
Eikelboom
B C
BC
D000368:Aged; D016001:Confidence Intervals; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007264:Inguinal Canal; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D011150:Popliteal Artery / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*