Distal bypass with the saphenous vein in situ. Technical aspects and early results.

The in situ saphenous vein graft has theoretical advantages, e.g. preservation of vasa vasorum and normally functioning endothelium, over the reversed vein graft and has gained popularity in recent years. Forty-three patients underwent 45 distal in situ saphenous vein bypasses for limb salvage during a 15-month period. The Hall valve stripper was found to be superior to the Mill valvulotome for valve incision. Intraarterial digital subtraction angiography (DSA) was a useful tool for perioperative anastomosis and graft evaluation. The incidence of early graft failure, 8/45 (18%), was mostly due to identifiable causes, mainly small caliber veins (less than 2.5 mm diameter). The cumulative patency rate of 77% remained stable during the follow-up period of 15 months. Perioperative mortality was zero. The main technical advantage with the in situ method is the reduced size disparity at the anastomotic sites. The in situ technique allowed the successful use of veins as small as 2.5 mm in diameter which resulted in a vein utilization rate of 95%. This rendered long distal bypasses possible in patients who could not have been reconstructed with the reversed vein technique.