In situ saphenous vein bypass: technical aspects and results

A consecutive series of 113 non-reversed saphenous vein grafts is presented to illustrate the technique of the procedure, modifications necessary to overcome its disadvantages and the results obtainable using such methods. The grafts were performed between January 1986 and January 1989. During this period vein utilization rate rose to more than 90%. Eighty-one procedures were performed for limb salvage (mean preoperative ankle pressure index: 0.32 +/- 0.16). Cumulative patency at 30 months was 88% (+/- 4%) for the 81 limb salvage procedures and 89% (+/- 3%) for the total 113 grafts in the series. Twelve grafts permanently failed. No graft has failed after 2 months. Amputation was avoided in 88% of limb salvage procedures. Operative mortality was 4.4%, the average age of those dying being 77 years. Fifty-three in situ grafts were followed prospectively after accurate mapping of their valve lysis was performed during surgery. Patterns of valve lysis and technical aspects related to the performance of in situ grafts will be presented.