Patency after revision surgery for failing infrainguinal vein grafts.
BACKGROUND
Although the results of bypass surgery on arteries in the lower extremities have been greatly improved during the last decades, there are still a significant number of primary failures. In order to investigate the reasons for the failure of autogenous vein grafts after infrainguinal arterial bypass surgery and to ascertain the results of revision operations on the failing grafts, we conducted a clinical study.


METHODS
Retrospective study on 104 patients who underwent infrainguinal arterial revascularisation with autogenous veins.


RESULTS
One hundred and twenty-six bypasses were constructed in 121 limbs. Seventy-nine of these were for claudication and 47 for threatened limbs (rest pain or ischaemic tissue loss). Five-year primary and secondary patency rates were 69.7% and 84.9% respectively. Spliced or suture-repaired grafts had a poor outcome; five out of seven eventually becoming thrombosed. On the other hand, revision operations for failing but not yet thrombosed grafts produced good results; the five-year primary patency rate after these operations was 76.0%, whereas after single-segment primary grafting it was 72.1%.


CONCLUSIONS
These results stress the importance of vigilant follow-up and active intervention for failing grafts. Poor outcome with injured vein grafts emphasizes the importance of meticulous vein harvesting.
Sato
O
O
Department of Surgery, Saitama Medical Center, Kawagoe, Japan.
Miyata
T
T
Deguchi
J
J
Kimura
H
H
Kondoh
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014680:Veins / Q000637:transplantation*