In situ saphenous vein bypass grafting. Experience in 34 extremities over a 2 year period

Over a 2 year period, 34 limbs were revascularized in 33 patients. The in situ saphenous vein technique was used. Improved instrumentation and patency rates have encouraged the use of this method. Eighteen patients were insulin-dependent diabetics. The indication for operation was limb salvage in 25 limbs (73 percent). No vein was considered too small to use. The origin of 25 of the grafts were femoral and 9, popliteal. The termination of 15 of the grafts were popliteal, 11 tibial or peroneal, and 8 pedal. Of 12 limbs considered to be the most difficult to treat due to diabetes and accompanying poor runoff, 4 had a patent pedal arch. Initial graft patency was achieved in 94 percent of the limbs. Overall graft patency was 73 percent; femoropopliteal patency was 86 percent; and combined femoral, tibial, peroneal, and pedal patency was 64 percent. Learning the in situ bypass technique is tedious. The low thrombogenicity of the graft provides a temptation to extend operative indications. Use of the saphenous vein in situ can result in superior revascularization of the leg.