[17 years experience with saphenous vein in situ bypass]

Long-term results of femorodistal in situ vein bypasses depend on the quality of the outflow tract. The cumulative patency of in situ bypasses to the third popliteal segment with a three-vessel runoff is 82.2% at 5 years, compared to 56% for bypasses to a single tibial artery. Immediate occlusions during the first 3 postoperative days are fatal for long-term permeability. After successful revision, the cumulative patency is only 39.5% at 5 years, compared to 64.9% for the whole group. A prospective randomized trial could show that an adjunct intra-arterial treatment with PGE 1 over 10 days can statistically significantly reduce the rate of fatal immediate occlusions.