title: Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass.
abstract: OBJECTIVE
  Gangrenous bowel, intraabdominal sepsis, and previous failed mesenteric bypass are indications for use of an autogenous conduit for mesenteric arterial reconstruction. Saphenous vein (SV) is often used as the autogenous conduit of choice, but it may be prone to graft stenosis or occlusion. Recent experience with superficial femoral vein (SFV) suggests that it is an excellent alternative conduit for major arterial reconstruction. The purpose of this study was to compare the outcomes of SV and SFV for mesenteric arterial bypass.
  
  
  METHODS
  During a 7-year period, 26 patients underwent 43 mesenteric arterial bypass procedures with autogenous conduit. SV was used for 23 bypasses (53%), and SFV was used for 20 bypasses (47%). Indications for revascularization included chronic mesenteric ischemia (n = 15; 58%), acute mesenteric ischemia (n = 9; 35%), and mycotic aneurysm of the paravisceral aorta (n = 2; 7%). Three patients (11%) underwent revascularization with SV grafts and two patients (8%) with SFV grafts after previous failed mesenteric bypass.
  
  
  RESULTS
  The 30-day mortality rate was 15%. Three deaths occurred after SV bypass for acute mesenteric ischemia, and one death occurred after a SFV bypass for a ruptured paravisceral mycotic aneurysm. Twenty-two surviving patients were followed for a mean of 31 +/- 6 months. Three of 11 patients (27%) who survived after SV bypass had recurrent mesenteric ischemia develop (acute, n = 1; chronic, n = 2) from graft thrombosis at a mean interval of 32 +/- 22 months after surgery. No patient had recurrent symptoms develop after SFV bypass. One of the three patients with SV graft failure died of acute mesenteric ischemia, and the other two patients underwent successful bypass with SFV. Symptomatic graft failure was significantly more likely to occur in patients receiving SV grafts compared with SFV grafts (P <.05).
  
  
  CONCLUSIONS
  SFV yields acceptable clinical outcomes for mesenteric arterial bypass compared with SV. SFV is a viable alternative to SV when autogenous conduit is indicated for mesenteric arterial reconstruction.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, TX 75390-9157, USA. greg.modrall@utsouthwestern.edu
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.forename: Javid
authors.initials: J
authors.lastname: Sadjadi
authors.forename: Donald R
authors.initials: DR
authors.lastname: Joiner
authors.forename: Ahsan
authors.initials: A
authors.lastname: Ali
authors.forename: M Burress
authors.initials: MB
authors.lastname: Welborn
authors.forename: Mark R
authors.initials: MR
authors.lastname: Jackson
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000503:physiopathology / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D015996:Survival Rate; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology