[Suggestion for differential use of graft materials in peripheral bypass operations]

Autologous great saphenous vein (AGSV) is admittedly the best graft for infrainguinal arterial reconstructions. It remains controversial, though, whether it should preferably be used "in situ" or "reversed". Even more controversial is the use of non-autologous grafts. Some authors prefer PTFE grafts for primary reconstructions in order to preserve the AGSV for secondary peripheral bypass or aortocoronary bypass procedures. We have reviewed recent studies comparing different graft materials. Several prospective studies show no significant difference between patency rates of "in situ" or "reversed" AGSV grafts in any position. We therefore feel that both methods are equivalent. In suprageniculate femoro-popliteal bypasses non-autologous grafts perform nearly as well as AGSV according to several studies. There preferential use seems justified, because many patients will ultimately need a secondary repair which has a dramatically higher patency when performed with AGSV. In infrageniculate femoro-popliteal bypasses AGSV does clearly better, but the use of non-autologous material may be justified under certain conditions. For femoro-crural bypasses there is no alternative so far to autologous veins. In patients without adequate AGSV alternate vein sources including the opposite leg and the arms should be used and veno-venous anastomoses should be made to construct conduits of adequate length. Some studies compare various non-autologous graft materials. Below the inguinal ligament, polytetrafluoroethylene seems to be todays standard. This is challenged by some recent results which need further confirmation.