Superficial femoral vein: a useful autogenous harvest site

The purpose of this study was to present the use of superficial femoral vein (SFV) as an arterial bypass graft when ipsilateral saphenous vein is inadequate.

Data collected prospectively were reviewed on 24 patients (25 limbs) who had an arterial bypass with SFV performed by the authors between January 1, 1988, and December 31, 1991. Many anatomic sites are represented. The indication for operation was gangrene in six patients, severe rest pain or ulceration in 11, mild to moderate rest pain in six, and graft infection in two. There had been 42 previous reconstructions in these 25 limbs.

There has been surprisingly little long-term disability from removal of the SFV. Immediately after surgery four limbs developed acute venous congestion that resolved quickly. Twenty percent of the patients with patent grafts have continued to wear a pressure gradient stocking for swelling 1 year after surgery, one patient requires additional pressure to control induration. All grafts were patent at 30 days. During a mean follow-up of 2 years, three grafts have required revision, and three have occluded. Stenosis did not develop at valve sites or in the body of the SFV portion of any of these grafts. There were two deaths from heart-related causes in the first 30 days after operation. Life-table analysis for the whole group shows a primary patency rate of 66% (SE 10.3%) and an assisted patency rate of 80% (SE 8.7%) at 2 years.

SFV harvest is well tolerated, even in the absence of ipsilateral saphenous vein. The magnitude of the operation is greater than saphenous vein harvest but yields a thick-walled vein of excellent diameter with many applications as an autogenous conduit, particularly where a large-diameter graft is indicated.