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Femoropopliteal in situ saphenous vein bypass: technical aspects and factors determining patency
J P Becquemin1, F Haiduc, J Labastie
1Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, Créteil, France.
Insights
Technique II, involving complete saphenous vein exposure and tributary ligation, significantly improved long-term bypass patency rates compared to Technique I. Close follow-up and reoperations further enhanced graft success.
Area of Science:
- Vascular Surgery
- Surgical Techniques
- Graft Patency
Background:
- Femoropopliteal bypass surgery is crucial for treating peripheral artery disease.
- Optimizing saphenous vein graft patency is essential for long-term limb salvage.
- Comparing different surgical techniques for in situ saphenous vein bypass is important.
Purpose of the Study:
- To retrospectively evaluate factors influencing long-term patency rates in two variations of femoropopliteal in situ saphenous vein bypass.
- To compare the outcomes of two distinct surgical techniques for saphenous vein harvesting and preparation.
Main Methods:
- Retrospective analysis of 33 patients (Technique I) and 55 patients (Technique II) undergoing femoropopliteal in situ saphenous vein bypass.
- Technique I: Limited saphenous vein approach, Cartier stripper for valve destruction, no tributary ligation.
- Technique II: Complete saphenous vein exposure, Hall's stripper for valve destruction, ligation of all tributaries.
Main Results:
- Early thrombosis rates were 21% (Technique I) vs. 3.6% (Technique II).
- Four-year secondary patency rates were 78.5% (Technique I) vs. 95% (Technique II) (p < 0.05).
- Distal anastomosis site significantly impacted patency (upper popliteal 100%, lower popliteal 93.6%, tibioperoneal 70.5%).
Conclusions:
- The in situ saphenous vein bypass using Technique II yielded superior results compared to Technique I.
- Close patient follow-up and timely reoperations are critical for enhancing graft patency.
- The location of the distal anastomosis is a significant predictor of long-term femoropopliteal bypass success.
Abstract:
The results and the factors influencing long-term patency rates in two technical variations of femoropopliteal "in situ" saphenous vein bypass procedures were evaluated retrospectively. Technique I (n = 33) consisted of a limited approach to the saphenous vein, destruction of the valves with a Cartier stripper and no tributary ligation. Technique II (n = 55) included complete exposure of the saphenous vein valvular destruction using Hall's stripper and ligation of all tributaries. Early thrombosis was observed in 21% and 3.6% of cases in techniques I and II, respectively. The frequency of local complications was identical in both techniques (18%). Overall actuarial primary patency at 4 years was 70%. Secondary patency (including patency following reoperations for graft failure) was 88% overall, 78.5% in technique I and 95% in technique II (p less than 0.05). The site of the distal anastomosis significantly influenced the four year cumulative patency rate (upper popliteal - 100%, lower popliteal - 93.6%, tibioperoneal vessels - 70.5%, p less than 0.05), whereas the number of patent leg vessels, the clinical stage of disease and the site of the proximal anastomosis (common femoral or superficial femoral artery) did not. Results obtained with the in situ saphenous vein bypass using technique II were better than with technique I. Close follow-up and preventive reoperations clearly enhanced patency rates. The site of distal anastomosis significantly affected long-term results.