[The vein as a transplant: aortocoronary and peripheral venous bypass]

Femoropopliteal bypass with below-the-knee anastomosis and the use of an autogenous saphenous vein yields the best results in longtime patency rate compared to the use of other graft materials. With anastomosis above the knee equally good results are also found with other graft materials. However, the late results show that even the saphenous vein is no perfect vessel substitute. Therefore, the indication for operation should be selected mainly for limb salvage and rest pain in stages III and IV, and the saphenous vein should be preserved for below-the-knee anastomosis. The greater saphenous vein for aorto-coronary bypass surgery is available in sufficient quantity, harvesting is quick and easy, and grafting can be done without great difficulty. The early results are good; the late patency rate again shows that the vein is no perfect vessel substitute and the results are inferior to those of the arteria mammaria grafts. The saphenous vein is the standard graft for aortocoronary bypass surgery and the graft of choice for emergency revascularization. The arteria mammaria graft to the left anterior descending is the better alternative. However, bilateral and complex mammary artery bypass grafting is only justified with comparable low operative mortality and morbidity. Because of the grafts disease the recommended norms for the surgical treatment of the coronary artery disease should include the use of the internal mammary artery on one hand, and appropriate early interventions for risk factors, including drug therapy, on the other hand. Prophylactic angioplasty of main-stem stenosis for the protection of functioning bypasses should also be considered.