Technical aspects and results of the open in situ saphenous vein bypass technique

We reviewed 284 consecutive in situ saphenous vein bypass procedures performed for limb salvage over a 66 month period. All procedures were performed using an open technique with a modified Mills retrograde valvulotome using an incision exposing the whole vein. Ninety-eight percent were to the infrageniculate level (18% below knee popliteal and 80% crural). All patients had preoperative B-mode saphenous vein mapping. Intraoperative arteriographic and continuous wave Doppler evaluations were done on each bypass. Routine color duplex imaging was performed on all bypassess postoperatively. Primary and secondary patency rates for all in situ bypassess at 48 months were 68% and 86%. The perioperative mortality was 2.5%. All deaths were secondary to cardiovascular causes. We believe that the open technique with a retrograde valvulotome provide satisfactory long-term patency, high operability and an excellent vein utilization rate.