[Femoro-popliteal bypass in situ]

The authors present early and late results of femoro-popliteal/crural reconstruction where "in situ" technic is used. Of 35 patients 10 had the third stage of occlusive disease by Fontain, and 25 were in the fourth stage. Therefore the reconstruction consisted of "limb salvage procedure". The aim of the study was to present the possibilities of this technique in cases with ischaemic extremities and poor "run off". The early potency of prosthesis within the first month was 97% (34 patients) and late (after one year) 91% (32 patients). In three patients, in early postoperative stage, AV fistulas were found and successfully surgically treated. AV fistulas were caused by non-ligated branches of the saphenous vein. Thus, a conclusion was drawn that intraoperative control angiography vas of great importance. Better potency of prosthesis, when compared to the quality of saphenous vein graft and when used "in situ", over the classical method was achieved thanks to the following facts: no damage of the intima caused by hydrostatic dilatation; possible use of a vein whose diameter is less than 4 mm; no damage of adventitia (vasa vasorum) due to the slower degenerative process of the vein wall; impossible graft torsion; low compliance level between the graft and the small artery, and small artery caused by the conic shape of graft.