Experience with distal in-situ vein grafts

Recent reported experience with in-situ vein grafting has been positive and encouraging. At the Queen Elizabeth Hospital in Charlottetown, PEI, since January 1983, 111 in-situ vein grafts have been placed. Fifty-one were to sites distal to the tibioperoneal trunk; 18 were to the ankle and foot and included grafts to the tarsal and plantar arteries. All patients requiring distal grafts complained of rest pain or had tissue necrosis. The early in-hospital and 1-month patency of the 51 distal grafts (93%) was similar to that of 60 femoropopliteal grafts (87%), but the 3-year patency rate of the distal grafts was only 50% compared with 82% for the femoropopliteal grafts. The high late failure rate of the distal grafts was disappointing. It was not related to the level of the distal anastomotic site in the lower leg or foot, to the level of the proximal anastomotic site, the particular vessel chosen for the distal site, or to whether the distal site was visualized by contrast roentgenography or located preoperatively by ultrasonography. Continued smoking was an important factor in failure, and mechanical trauma to the distal saphenous vein may have been important. Intimal hyperplasia was the usual cause of failure and may be a negative aspect of the vitality of in-situ vein grafts. Its clinical presentation and histologic features were florid and distinctive.