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. 1991 May;213(5):457–465. doi: 10.1097/00000658-199105000-00011

Femoral-distal bypass with in situ greater saphenous vein. Long-term results using the Mills valvulotome.

M C Donaldson 1, J A Mannick 1, A D Whittemore 1
PMCID: PMC1358473  PMID: 2025066

Abstract

During a 7-year period, 440 consecutive in situ saphenous vein grafts originating in the groin were performed in 371 patients, exposing the entire vein for valvulotomy with a modified Mills valvulotome. critical ischemia was the indication for bypass in 68%, and the distal anastomosis was to an infrapopliteal artery in 46%. Thirty-day operative mortality was 2.0%. Postoperative surveillance identified 18 stenotic grafts (4.1%), which were revised while still patent (primary revised patency); 36 grafts (8.2%) underwent revision after graft occlusion (secondary patency). Five-year life-table analysis showed overall primary revised patency of 78%, secondary patency of 83%, limb salvage of 88%, and patient survival of 66%. Femoroperoneal and inframalleolar bypasses fared well. The presence of diabetes did not diminish late graft patency. In contrast to reversed vein grafts, long infrapopliteal in situ grafts had long-term secondary patency similar to shorter femoropopliteal bypass grafts (p greater than 0.05). These results, coupled with the versatility and simplicity of the technique as used in the present series, suggest that in situ vein grafting is the procedure of choice for long infrapopliteal bypass.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bandyk D. F., Cato R. F., Towne J. B. A low flow velocity predicts failure of femoropopliteal and femorotibial bypass grafts. Surgery. 1985 Oct;98(4):799–809. [PubMed] [Google Scholar]
  2. Bandyk D. F., Kaebnick H. W., Stewart G. W., Towne J. B. Durability of the in situ saphenous vein arterial bypass: a comparison of primary and secondary patency. J Vasc Surg. 1987 Feb;5(2):256–268. doi: 10.1067/mva.1987.avs0050256. [DOI] [PubMed] [Google Scholar]
  3. Bandyk D. F., Schmitt D. D., Seabrook G. R., Adams M. B., Towne J. B. Monitoring functional patency of in situ saphenous vein bypasses: the impact of a surveillance protocol and elective revision. J Vasc Surg. 1989 Feb;9(2):286–296. [PubMed] [Google Scholar]
  4. Bandyk D. F., Towne J. B., Schmitt D. D., Seabrook G. R., Bergamini T. M. Therapeutic options for acute thrombosed in situ saphenous vein arterial bypass grafts. J Vasc Surg. 1990 May;11(5):680–687. [PubMed] [Google Scholar]
  5. Belkin M., Donaldson M. C., Whittemore A. D., Polak J. F., Grassi C. J., Harrington D. P., Mannick J. A. Observations on the use of thrombolytic agents for thrombotic occlusion of infrainguinal vein grafts. J Vasc Surg. 1990 Feb;11(2):289–296. doi: 10.1067/mva.1990.17565. [DOI] [PubMed] [Google Scholar]
  6. Berkowitz H. D., Greenstein S. M. Improved patency in reversed femoral-infrapopliteal autogenous vein grafts by early detection and treatment of the failing graft. J Vasc Surg. 1987 May;5(5):755–761. doi: 10.1067/mva.1987.avs0050755. [DOI] [PubMed] [Google Scholar]
  7. Donaldson M. C. Doppler detection of arteriovenous fistulas after in situ saphenous vein bypass. Am J Surg. 1988 Feb;155(2):263–265. doi: 10.1016/s0002-9610(88)80710-4. [DOI] [PubMed] [Google Scholar]
  8. Donaldson M. C. Lessons from initial experience with the in situ saphenous vein graft. Arch Surg. 1984 Jul;119(7):766–769. doi: 10.1001/archsurg.1984.01390190010002. [DOI] [PubMed] [Google Scholar]
  9. Donaldson M. C., Weinberg D. S., Belkin M., Whittemore A. D., Mannick J. A. Screening for hypercoagulable states in vascular surgical practice: a preliminary study. J Vasc Surg. 1990 Jun;11(6):825–831. doi: 10.1067/mva.1990.20120. [DOI] [PubMed] [Google Scholar]
  10. Donaldson M. C., Whittemore A. D., Mannick J. A. An argument in favor of all-autogenous tissue for vascular bypasses below the inguinal ligament. Adv Surg. 1991;24:69–90. [PubMed] [Google Scholar]
  11. Fleisher H. L., 3rd, Thompson B. W., McCowan T. C., Ferris E. J., Baker M. L., Robbins K. V., Barnes R. W. Angioscopically monitored saphenous vein valvulotomy. J Vasc Surg. 1986 Oct;4(4):360–364. [PubMed] [Google Scholar]
  12. Fogle M. A., Whittemore A. D., Couch N. P., Mannick J. A. A comparison of in situ and reversed saphenous vein grafts for infrainguinal reconstruction. J Vasc Surg. 1987 Jan;5(1):46–52. [PubMed] [Google Scholar]
  13. Green R. M., McNamara J., Ouriel K., DeWeese J. A. Comparison of infrainguinal graft surveillance techniques. J Vasc Surg. 1990 Feb;11(2):207–215. [PubMed] [Google Scholar]
  14. HALL K. V. The great saphenous vein used in situ as an arterial shunt after extirpation of the vein valves. A preliminary report. Surgery. 1962 Apr;51:492–495. [PubMed] [Google Scholar]
  15. Harris P. L., How T. V., Jones D. R. Prospectively randomized clinical trial to compare in situ and reversed saphenous vein grafts for femoropopliteal bypass. Br J Surg. 1987 Apr;74(4):252–255. doi: 10.1002/bjs.1800740409. [DOI] [PubMed] [Google Scholar]
  16. Karmody A. M., Leather R. P., Shah D. M., Corson J. D., Naraynsingh V. Peroneal artery bypass: a reappraisal of its value in limb salvage. J Vasc Surg. 1984 Nov;1(6):809–816. [PubMed] [Google Scholar]
  17. Kent K. C., Whittemore A. D., Mannick J. A. Short-term and midterm results of an all-autogenous tissue policy for infrainguinal reconstruction. J Vasc Surg. 1989 Jan;9(1):107–114. doi: 10.1067/mva.1989.vs0090107. [DOI] [PubMed] [Google Scholar]
  18. Le Heron D., Serise J. M., Tingaud R., Basse-Cathalinat B., Baquey C. Postoperative evaluation of in situ saphenous vein bypass with technetium-labelled albumin microspheres. Tex Heart Inst J. 1982 Mar;9(1):27–32. [PMC free article] [PubMed] [Google Scholar]
  19. Leather R. P., Powers S. R., Karmody A. M. A reappraisal of the in situ saphenous vein arterial bypass: its use in limb salvage. Surgery. 1979 Sep;86(3):453–461. [PubMed] [Google Scholar]
  20. Leather R. P., Shah D. M., Chang B. B., Kaufman J. L. Resurrection of the in situ saphenous vein bypass. 1000 cases later. Ann Surg. 1988 Oct;208(4):435–442. doi: 10.1097/00000658-198810000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Leather R. P., Shan D. M., Karmody A. M. Infrapopliteal arterial bypass for limb salvage: increased patency and utilization of the saphenous vein used "in situ". Surgery. 1981 Dec;90(6):1000–1008. [PubMed] [Google Scholar]
  22. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
  23. Miller A., Campbell D. R., Gibbons G. W., Pomposelli F. B., Jr, Freeman D. V., Jepsen S. J., Lees R. S., Isaacsohn J. L., Purcell D., Bolduc M. Routine intraoperative angioscopy in lower extremity revascularization. Arch Surg. 1989 May;124(5):604–608. doi: 10.1001/archsurg.1989.01410050094019. [DOI] [PubMed] [Google Scholar]
  24. Mills J. L., Harris E. J., Taylor L. M., Jr, Beckett W. C., Porter J. M. The importance of routine surveillance of distal bypass grafts with duplex scanning: a study of 379 reversed vein grafts. J Vasc Surg. 1990 Oct;12(4):379–389. [PubMed] [Google Scholar]
  25. Mills N. L., Ochsner J. L. Valvulotomy of valves in the saphenous vein graft before coronary artery bypass. J Thorac Cardiovasc Surg. 1976 Jun;71(6):878–879. [PubMed] [Google Scholar]
  26. Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1986 Jul;4(1):80–94. [PubMed] [Google Scholar]
  27. Szilagyi D. E., Elliott J. P., Hageman J. H., Smith R. F., Dall'olmo C. A. Biologic fate of autogenous vein implants as arterial substitutes: clinical, angiographic and histopathologic observations in femoro-popliteal operations for atherosclerosis. Ann Surg. 1973 Sep;178(3):232–246. doi: 10.1097/00000658-197309000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Taylor L. M., Jr, Edwards J. M., Porter J. M. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990 Feb;11(2):193–206. doi: 10.1067/mva.1990.17235. [DOI] [PubMed] [Google Scholar]
  29. Whittemore A. D., Clowes A. W., Couch N. P., Mannick J. A. Secondary femoropopliteal reconstruction. Ann Surg. 1981 Jan;193(1):35–42. doi: 10.1097/00000658-198101000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]

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