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. 1988 Oct;208(4):435–442. doi: 10.1097/00000658-198810000-00005

Resurrection of the in situ saphenous vein bypass. 1000 cases later.

R P Leather 1, D M Shah 1, B B Chang 1, J L Kaufman 1
PMCID: PMC1493749  PMID: 3178331

Abstract

Distal bypasses for the terminal stages of atherosclerotic occlusive disease manifest by chronic limb-threatening ischemia are among the most challenging arterial reconstructive procedures of surgeons today. The length and low flow rates of distal bypasses often exceed the functional limits of synthetic and even free vein grafts. However, the saphenous vein, when used in situ, provides a unique, viable, physiologically active, and hence antithrombogenic endothelial flow surface that is ideally suited for such bypasses. This paper presents the experience of the Albany Medical Center Hospital with the first 1000 in situ bypasses performed by the valve incision method over a 12-year period. Limb-threatening ischemia was the most common indication for surgery (91%). An in situ bypass was attempted in over 95% of unselected limbs and were completed in situ and in toto in 94%. 66% of the bypasses were carried out to the infrapopliteal level, and in more than 50% of the limbs, the distal vein diameter was less than 3.5 mm. The 30-day patency rate was 95%, and the cumulative patency rates, by life table analysis at 1, 2, 3, 4, and 5 years, were 90%, 86%, 84%, 80%, and 76%, respectively. The vein diameter, specific outflow vessel, level of distal anastomosis (length of bypass), inguinal inflow source used, and instrumental evolution had no significant effect on immediate or long-term bypass performance.

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Selected References

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  1. Abbott W. M., Wieland S., Austen W. G. Structural changes during preparation of autogenous venous grafts. Surgery. 1974 Dec;76(6):1031–1040. [PubMed] [Google Scholar]
  2. Ascer E., Veith F. J., Gupta S. K., White S. A., Bakal C. W., Wengerter K., Sprayregen S. Short vein grafts: a superior option for arterial reconstructions to poor or compromised outflow tracts? J Vasc Surg. 1988 Feb;7(2):370–378. doi: 10.1067/mva.1988.avs0070370. [DOI] [PubMed] [Google Scholar]
  3. 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]
  4. 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]
  5. Bonchek L. I. Prevention of endothelial damage during preparation of saphenous veins for bypass grafting. J Thorac Cardiovasc Surg. 1980 Jun;79(6):911–915. [PubMed] [Google Scholar]
  6. Brody W. R., Kosek J. C., Angell W. W. Changes in vein grafts following aorto-coronary bypass induced by pressure and ischemia. J Thorac Cardiovasc Surg. 1972 Dec;64(6):847–854. [PubMed] [Google Scholar]
  7. Buchbinder D., Rollins D. L., Semrow C. M., Schuler J. J., Meyer J. P., Flanigan D. P. In situ tibial reconstruction. State-of-the-art or passing fancy. Ann Surg. 1988 Feb;207(2):184–188. doi: 10.1097/00000658-198802000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Denton M. J., Hill D., Fairgrieve J. In situ femoropopliteal and distal vein bypass for limb salvage--experience of 50 cases. Br J Surg. 1983 Jun;70(6):358–361. doi: 10.1002/bjs.1800700617. [DOI] [PubMed] [Google Scholar]
  10. Fietze-Fischer B., Gruss J. D., Bartels D., Vargas-Montano H., Stritter W. Prostaglandin E1 as an adjuvant therapy in the event of femoropopliteal and crural great saphenous vein in situ bypass surgery. Vasa Suppl. 1987;17:23–25. [PubMed] [Google Scholar]
  11. 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]
  12. 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]
  13. 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]
  14. 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]
  15. Leather R. P., Shah D. M., Corson J. D., Karmody A. M. Instrumental evolution of the valve incision method of in situ saphenous vein bypass. J Vasc Surg. 1984 Jan;1(1):113–123. doi: 10.1067/mva.1984.avs0010113. [DOI] [PubMed] [Google Scholar]
  16. Leather R. P., Shah D. M. Experiences with in situ lower extremity saphenous vein bypass procedures. Surg Annu. 1988;20:257–271. [PubMed] [Google Scholar]
  17. 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]
  18. Leopold P. W., Chang B. B., Shandall A. A., Fitzgerald K. M., Shah D. M., Leather R. P., Corson J. D., Karmody A. M. Transcutaneous flow measurements in in-situ bypasses: an assessment of duplex scanning. Angiology. 1986 Mar;37(3 Pt 1):143–148. doi: 10.1177/000331978603700301. [DOI] [PubMed] [Google Scholar]
  19. Leopold P. W., Shandall A. A., Corson J. D., Shah D. M., Leather R. P., Karmody A. M. Initial experience comparing B-mode imaging and venography of the saphenous vein before in situ bypass. Am J Surg. 1986 Aug;152(2):206–210. doi: 10.1016/0002-9610(86)90243-6. [DOI] [PubMed] [Google Scholar]
  20. McGeachie J., Campbell P., Prendergast F. Vein to artery grafts. A quantitative study of revascularization by vasa vasorum and its relationship to intimal hyperplasia. Ann Surg. 1981 Jul;194(1):100–107. doi: 10.1097/00000658-198107000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Shah D. M., Chang B. B., Leopold P. W., Corson J. D., Leather R. P., Karmody A. M. The anatomy of the greater saphenous venous system. J Vasc Surg. 1986 Feb;3(2):273–283. [PubMed] [Google Scholar]
  22. Shearman C. P., Gannon M. X., Gwynn B. R., Simms M. H. A clinical method for the detection of arteriovenous fistulas during in situ great saphenous vein bypass. J Vasc Surg. 1986 Dec;4(6):578–581. doi: 10.1067/mva.1986.avs0040578. [DOI] [PubMed] [Google Scholar]
  23. Taylor L. M., Jr, Edwards J. M., Phinney E. S., Porter J. M. Reversed vein bypass to infrapopliteal arteries. Modern results are superior to or equivalent to in-situ bypass for patency and for vein utilization. Ann Surg. 1987 Jan;205(1):90–97. doi: 10.1097/00000658-198701000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Veith F. J., Weiser R. K., Gupta S. K., Ascer E., Scher L. A., Samson R. H., White-Flores S. A., Sprayregen S. Diagnosis and management of failing lower extremity arterial reconstructions prior to graft occlusion. J Cardiovasc Surg (Torino) 1984 Sep-Oct;25(5):381–384. [PubMed] [Google Scholar]

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