title: Contemporary results after sapheno-popliteal bypass for chronic femoral vein occlusion.
abstract: BACKGROUND
  Chronic occlusion of the femoral or the proximal popliteal vein responsible for venous obstruction and the constellation of clinical sequelae that ensue remains a surgical challenge that carries notable patient morbidity. Sapheno-popliteal bypass (SPB) remains a surgical reconstructive option for select patients that demonstrate patency of the popliteal vein, great saphenous vein, saphenofemoral junction, and iliac veins. We sought to analyze our single-institution experience with this technique.
  
  
  METHODS
  A retrospective review of a single-center experience with SPB was performed. Preoperative risk factors and indications for intervention (ie, venous claudication, ulceration) were identified. Duration of follow-up and endpoints, including clinical improvement, wound healing, patency, and limb loss were assessed. A Kaplan-Meier analysis for primary and secondary patency was performed.
  
  
  RESULTS
  Seventeen patients underwent SPB for chronic lower extremity venous obstruction between July 1988 and August 2011. Median age at operation was 41 years (range, 23-69 years). There was a male predominance noted (n = 12; 71%). All patients had chronic edema and venous claudication. Five patients (29%) had evidence of venous ulceration preoperatively. Eight patients (47%) underwent a preceding venous intervention (ie, iliac stenting or venous thrombolysis). Three patients had a concomitant arteriovenous fistula, created at the time of bypass to enhance in-flow; three patients underwent concomitant femoral-femoral venous bypass. Four patients (24%) experienced hematoma postoperatively that required operative evacuation; in two patients, compression from this hematoma resulted in early graft occlusion. After a median follow-up of 103 months (range, 3-271 months), 82% of patients experienced near or complete resolution of venous claudication. Three of the five patients with venous ulceration healed their wounds (67%). Of the 16 patients that underwent Duplex scan follow-up, primary patency after a median follow-up of 103 months was 56%, primary-assisted patency was 69%, and secondary patency was 75%. One patient required amputation approximately 21 years after SPB and there were no deaths. This secondary patency rate exceeds previously published patency rates.
  
  
  CONCLUSIONS
  SPB may be indicated for certain patients with chronic venous stasis disease secondary to femoral venous obstruction that have failed other standard therapies. SPB remains a satisfactory and reliable procedure that produces clinical improvement in a selected group of patients and should be considered in a contemporary venous surgical practice.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich. Electronic address: dawnbarn@umich.edu.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Vandy
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wakefield