title: Vein harvesting and techniques for infrainguinal bypass.
abstract: In order to achieve good long term results after bypass surgery, alongside with good inflow and outflow arteries, the bypass graft material also has an important role. The best patency and limb salvage rates are achieved with autologous vein. If great saphenous vein is not available, acceptable long-term results can be achieved with arm veins and lesser saphenous vein. The quality and size of the vein are important. A small-caliber vein, increased wall thickness, postphlebitic changes and varicosities are associated with a risk of early failure. Preoperative vein mapping with ultrasound reduces readmissions and postoperative surgical site infections. During the mapping, the vein to be used and its main tributaries are marked with a permanent marker pen. To reduce wound complication rates we recommend bridged incisions in vein harvesting. Endoscopic vein harvesting seems to have no benefit compared to open techniques in lower limb bypasses, and has been associated with higher risk of primary patency loss at one year. With deep tunneling of the graft the problems caused by wound infection can be avoided.
authors.affiliation: Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland - anders.alback@hus.fi.
authors.forename: Anders
authors.initials: A
authors.lastname: Albäck
authors.forename: Eva
authors.initials: E
authors.lastname: Saarinen
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply*; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014680:Veins / Q000637:transplantation*