INSITU SAPHENOUS-VEIN ARTERIAL BYPASS FOR INFRAINGUINAL REVASCULARIZATION - INITIAL EXPERIENCE USING AN OPEN TECHNIQUE

The Authors describe their initial experience with the use of the in situ saphenous vein arterial by-pass technique for infrainguinal revascularization. From December 1986 to August 1989, we performed 101 in situ saphenous vein arterial by-passes. From these 101 bypass, 18 composite or partial in situ vein by-passes (in situ + reversed vein) and 2 extra-anatomical sequencial by-passes (one axillofemoral and one cross-over femorofemoral proximal by-passes extended by in situ saphenous vein femoropopliteal arterial by-passes) were withdrawn from the statistics, with the purpose of analysing the natural evolution of the in situ vein arterial by-pass without the insertion of reversed vein segments and/or the influence of artificial grafts to improve arterial inflow. Therefore only 81 in situ by-pass cases will be analysed in the present paper. From these 81 cases, 44 (54.3%) were performed in diabetic patients and limb salvage was the indication for by-pass in 63 (81%). The saphenous vein valves were rendered incompetent utilising the retrograde Mills-Leather valvulotome and exposing the greater saphenous vein with a continuous incision. In the 81 cases, wound complications occurred in 18 limbs (22%) and operative mortality (30 days) was 6.1%. Primary cumulative patency rate of the 81 cases was 77% and secondary cumulative patency rate was 80%, at the end of the analysed period. The open technique, using a retrograde valvulotome and exposing the entire conduit of the greater saphenous vein, became our preferred technique for infrainguinal revascularization.