Peripheral reconstruction when adequate saphenous vein is lacking

For arterial reconstructions below the inguinal ligament without the use of autologous saphenous vein a critical question is the location of the distal anastomosis. In femoropopliteal bypass above the knee either umbilical vein grafts or PTFE grafts can be used with reasonable success. Externally supported Dacron grafts have given excellent results in some series. Endarterectomy and patch graft angioplasty may be used when implantation of foreign material should be avoided. Some investigators have found the umbilical vein graft superior to PTFE grafts for below knee reconstructions. For leg artery reconstructions we feel that at least a segment of autologous vein is needed to get a reconstruction with a satisfactory patency rate.