Long-term results of infrageniculate bypass grafting using all-autogenous composite vein.
Infrageniculate (below-knee) bypass using all-autogenous composite vein requires multiple incisions, venovenostomy, and prolonged operating time. The purpose of this study was to evaluate the long-term results of this procedure, with comparisons to grafts created from single-segment greater saphenous vein (GSV) or polytetrafluoroethylene (PTFE). A total of 362 consecutive infrainguinal bypass grafts with infrageniculate distal target arteries were created in 283 patients in a single institution between January 1995 and December 2000. Comorbid conditions were common, including diabetes (58%), coronary artery disease (56%), prior lower extremity revascularization (41%), end-stage renal failure (20%), and prior coronary artery bypass grafting (18%). The indication for revascularization was limb salvage in 93% of cases. The grafts were constructed from single segments of GSV (n = 239), from two or more vein segments resulting in an all-autogenous composite graft (n = 61), or from PTFE (n = 62). All-autogenous composite grafts were constructed using segments of ipsilateral or contralateral GSV (n = 49), upper extremity vein (n = 23), superficial femoral vein (n = 7), or lesser saphenous vein (n = 5). Infrageniculate all-autogenous composite vein grafts exhibited similar long-term results to those of GSV grafts, and far superior results to those of PTFE grafts. For patients with available autogenous segments, the all-autogenous composite vein graft is the conduit of choice.
Curi
Michael A
MA
Department of Surgery, Section of Vascular Surgery, University of Chicago, Chicago, IL, USA.
Skelly
Christopher L
CL
Woo
David H
DH
Desai
Tina R
TR
Katz
Daniel
D
McKinsey
James F
JF
Bassiouny
Hisham S
HS
Gewertz
Bruce L
BL
Schwartz
Lewis B
LB
D000368:Aged; D002641:Chicago; D015331:Cohort Studies; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay; D008297:Male; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000473:pathology / Q000601:surgery; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology; D014656:Vascular Surgical Procedures
D011138:Polytetrafluoroethylene