[In situ saphenous vein arterial bypass for lower limb ischemia]

28 patients with 30 ischemic lower limbs were treated by in situ saphenous vein femorodistal arterial bypass using self-made valvulotome at Zhongshan Hospital from 1989 to 1994. All patients had claudication in the lower extremities and were diagnosed angiographically. The preoperative ABI was from 0 to 0.57 (mean 0.41). All the vein grafts were patent postoperation and the dorsalis pedis or posterior tibial arteries were palpable in 18 legs immediately postoperation and the dorsalis pedis or comitant arterial reconstruction. Graft occlusion within 3 days after original operations occurred in three cases and secondary surgical corrections were successful. Postoperative mean ABI increased from 0.41 to 0.84. The limb salvage rate was 100% and the cumulative patency rate, by the lifetable analysis in 1, 2, 3, 4 and 5 years, were 92%, 88%, 86%, 78% and 71% respectively. The results suggest that the in situ saphenous vein arterial bypass is the superior method for distal arterial reconstruction and concomitant procedures to ensure sufficient inflow as well as outflow are essential to the patency of the graft.