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Peripheral reconstruction when adequate saphenous vein is lacking
Acta Chirurgica Scandinavica. Supplementum
|January 1, 1985
Summary
For leg artery reconstructions, using autologous vein segments is crucial for achieving satisfactory patency rates. Other graft options like PTFE or umbilical vein grafts show variable success, especially below the knee.
Area of Science:
- Vascular Surgery
- Biomaterials in Medicine
- Reconstructive Surgery
Background:
- Determining the optimal distal anastomosis site is critical for arterial reconstructions below the inguinal ligament when autologous saphenous vein is not used.
- Various graft materials, including umbilical vein, PTFE, and externally supported Dacron, have been employed for femoropopliteal bypass with differing outcomes.
- Endarterectomy and patch graft angioplasty offer alternatives to synthetic grafts when foreign material implantation is undesirable.
Purpose of the Study:
- To evaluate the effectiveness of different graft materials and techniques for arterial reconstructions below the inguinal ligament.
- To compare the patency rates of various grafts, specifically in femoropopliteal and below-knee reconstructions.
- To determine the necessity of autologous vein for successful leg artery reconstructions.
Main Methods:
- Review of existing literature and clinical series comparing different graft types (umbilical vein, PTFE, Dacron) and procedures (endarterectomy, patch angioplasty).
- Analysis of success rates and patency data for above-knee versus below-knee femoropopliteal bypass.
- Assessment of outcomes based on the use of autologous vein segments versus synthetic or alternative grafts.
Main Results:
- Umbilical vein grafts and PTFE grafts demonstrate reasonable success in above-knee femoropopliteal bypass.
- Externally supported Dacron grafts have shown excellent results in some reported series.
- Some studies indicate umbilical vein grafts may be superior to PTFE grafts for below-knee reconstructions.
Conclusions:
- For leg artery reconstructions, the use of at least a segment of autologous vein is recommended to achieve satisfactory patency rates.
- The choice of graft material and anastomosis site significantly impacts the success of arterial reconstructions below the inguinal ligament.
- While synthetic grafts have utility, autologous vein remains a key component for durable below-knee arterial reconstructions.