Abstract
In recent years many reports have attributed improved patency and improved vein utilization with lower extremity arterial bypass to infrapopliteal arteries to the use of the in-situ vein graft technique (ISVB). This report describes 110 reversed vein bypasses (RVB) to infrapopliteal arteries performed from 1980-1986. Thirty-three per cent of these patients did not have an intact ipsilateral greater saphenous vein. One hundred per cent of patients had autogenous RVB performed using a variety of techniques, including vein splicing, use of arm veins, lesser saphenous veins, branch veins, and use of graft origins distal to the common femoral artery. The life table patency figures for these grafts are 90%, 85%, and 85% at 1 year, 3 years, and 5 years, respectively. The life table limb salvage at 5 years is 93%. These figures for patency, vein utilization, and limb salvage for modern RVB to infrapopliteal arteries are clearly equal to or superior to any reported figures for ISVB. Results for RVB are greatly improved when compared with historic controls, as are results for ISVB. There is no evidence to date demonstrating superiority of one technique versus another.
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- Baur G. M., Zupan T. L., Gates K. H., Porter J. M. Blood flow in the common femoral artery. Evaluation in a vascular laboratory. Am J Surg. 1983 May;145(5):585–588. doi: 10.1016/0002-9610(83)90097-1. [DOI] [PubMed] [Google Scholar]
- Buchbinder D., Rolins D. L., Verta M. J., LaRosa M. P., Ryan T. J., Meyer J. P., Flanigan D. P. Early experience with in situ saphenous vein bypass for distal arterial reconstruction. Surgery. 1986 Mar;99(3):350–357. [PubMed] [Google Scholar]
- Bush H. L., Jr, Graber J. N., Jakubowski J. A., Hong S. L., McCabe M., Deykin D., Nabseth D. C. Favorable balance of prostacyclin and thromboxane A2 improves early patency of human in situ vein grafts. J Vasc Surg. 1984 Jan;1(1):149–159. [PubMed] [Google Scholar]
- Cantelmo N. L., Snow J. R., Menzoian J. O., LoGerfo F. W. Successful vein bypass in patients with an ischemic limb and a palpable popliteal pulse. Arch Surg. 1986 Feb;121(2):217–220. doi: 10.1001/archsurg.1986.01400020103012. [DOI] [PubMed] [Google Scholar]
- Carney W. I., Jr, Balko A., Barrett M. S. In situ femoropopliteal and infrapopliteal bypass. Two-year experience. Arch Surg. 1985 Jul;120(7):812–816. doi: 10.1001/archsurg.1985.01390310050011. [DOI] [PubMed] [Google Scholar]
- Chesebro J. H., Clements I. P., Fuster V., Elveback L. R., Smith H. C., Bardsley W. T., Frye R. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982 Jul 8;307(2):73–78. doi: 10.1056/NEJM198207083070201. [DOI] [PubMed] [Google Scholar]
- Christenson J. T., Broomé A., Norgren L., Eklöf B. Revascularization of popliteal and below-knee arteries with polytetrafluoroethylene. Surgery. 1985 Feb;97(2):141–149. [PubMed] [Google Scholar]
- Corson J. D., Leather R. P., Balko A., Naraynsingh V., Karmody A. M., Shah D. M. Relationship between vasa vasorum and blood flow to vein bypass endothelial morphology. Arch Surg. 1985 Mar;120(3):386–388. doi: 10.1001/archsurg.1985.01390270124022. [DOI] [PubMed] [Google Scholar]
- DALE W. A. Grafting small arteries. Experience with 19 shunts below the knee. Arch Surg. 1963 Jan;86:22–33. doi: 10.1001/archsurg.1963.01310070024004. [DOI] [PubMed] [Google Scholar]
- Dardik H., Ibrahim I. M., Dardik I. I. The role of the peroneal artery for limb salvage. Ann Surg. 1979 Feb;189(2):189–198. doi: 10.1097/00000658-197902000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ferguson I. A., Rosengarten D. S., Stuchbery F. E., Barnett A. J. Arterial reconstruction extending below the popliteal bifurcation. Br J Surg. 1978 Jun;65(6):410–412. doi: 10.1002/bjs.1800650612. [DOI] [PubMed] [Google Scholar]
- Gruss J. D., Bartels D., Vargas H., Karadedos C., Schlechtweg B. Arterial reconstruction for distal disease of the lower extremities by the in situ vein graft technique. J Cardiovasc Surg (Torino) 1982 May-Jun;23(3):231–234. [PubMed] [Google Scholar]
- 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]
- Harris R. W., Andros G., Dulawa L. B., Oblath R. W., Salles-Cunha S. X., Apyan R. Successful long-term limb salvage using cephalic vein bypass grafts. Ann Surg. 1984 Dec;200(6):785–792. doi: 10.1097/00000658-198412000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leather R. P. In situ saphenous vein arterial bypass to the tibial arteries. J Vasc Surg. 1984 Nov;1(6):912–913. [PubMed] [Google Scholar]
- 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]
- Levine A. W., Bandyk D. F., Bonier P. H., Towne J. B. Lessons learned in adopting the in situ saphenous vein bypass. J Vasc Surg. 1985 Jan;2(1):145–153. [PubMed] [Google Scholar]
- Little J. M., Petritsi-Jones D., Zylstra P., Williams R., Kerr C. A survey of amputations for degenerative vascular disease. Med J Aust. 1973 Feb 17;1(7):329–334. doi: 10.5694/j.1326-5377.1973.tb200046.x. [DOI] [PubMed] [Google Scholar]
- Little J. M. Successful amputation--by whose standards? Am Heart J. 1975 Dec;90(6):806–807. doi: 10.1016/0002-8703(75)90474-3. [DOI] [PubMed] [Google Scholar]
- MORRIS G. C., Jr, DE BAKEY M. E., COOLEY D. A., CRAWFORD E. S. Arterial bypass below the knee. Surg Gynecol Obstet. 1959 Mar;108(3):321–332. [PubMed] [Google Scholar]
- Robison J. G., Brewster D. C., Abbott W. M., Darling R. C. Femoropopliteal and tibioperoneal artery reconstruction using human umbilical vein. Arch Surg. 1983 Sep;118(9):1039–1042. doi: 10.1001/archsurg.1983.01390090029006. [DOI] [PubMed] [Google Scholar]
- Rutherford R. B., Jones D. N., Bergentz S. E., Bergqvist D., Karmody A. M., Dardik H., Moore W. S., Goldstone J., Flinn W. R., Comerota A. J. The efficacy of dextran 40 in preventing early postoperative thrombosis following difficult lower extremity bypass. J Vasc Surg. 1984 Nov;1(6):765–773. [PubMed] [Google Scholar]
- Taylor L. M., Jr, Baur G. M., Eidemiller L. R., Porter J. M. Extended profundaplasty. Indications and techniques with results of 46 procedures. Am J Surg. 1981 May;141(5):539–542. doi: 10.1016/0002-9610(81)90043-x. [DOI] [PubMed] [Google Scholar]
- Taylor L. M., Jr, Freimanis I. E., Edwards J. M., Porter J. M. Extraperitoneal iliac endarterectomy in the treatment of multilevel lower extremity arterial occlusive disease. Am J Surg. 1986 Jul;152(1):34–39. doi: 10.1016/0002-9610(86)90133-9. [DOI] [PubMed] [Google Scholar]
- Turnipseed W., Evans W., Vasko J. S. Preservation of the ischemic leg by distal vascular bypass. Ann Surg. 1977 Nov;186(5):659–662. doi: 10.1097/00000658-197711000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Veith F. J., Gupta S. K., Ascer E., White-Flores S., Samson R. H., Scher L. A., Towne J. B., Bernhard V. M., Bonier P., Flinn W. R. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg. 1986 Jan;3(1):104–114. doi: 10.1067/mva.1986.avs0030104. [DOI] [PubMed] [Google Scholar]
- Veith F. J., Gupta S. K., Samson R. H., Flores S. W., Janko G., Scher L. A. Superficial femoral and popliteal arteries as inflow sites for distal bypasses. Surgery. 1981 Dec;90(6):980–990. [PubMed] [Google Scholar]
- Whitehouse F. W., Jurgensen C., Block M. A. The later life of the diabetic amputee. Another look at fate of the second leg. Diabetes. 1968 Aug;17(8):520–521. doi: 10.2337/diab.17.8.520. [DOI] [PubMed] [Google Scholar]




