An 11-year experience with deep leg veins as femoropopliteal bypass grafts.

Since 1974, 82 primary femoropopliteal bypasses were performed using superficial femoral, popliteal, and deep femoral veins exclusively. Saphenous nonavailability dictated usage in 20 cases, and 62 grafts were placed as part of a randomized comparative study with saphenous veins. Cumulative life table patency rates at 1, 2, 3, 4, and 5 years were 89%, 87%, 70%, 60%, and 60%. Surgical indications were critical ischemia (n = 77) and claudication (n = 5). Late stasis changes and ulceration did not occur and six-month ankle swellings were only 0.58 cm greater than in patients with saphenous vein grafts. Routine periodic postoperative angiography (256 studies in 74 patients) allowed informed evaluation of most late graft failures. Occlusions in the first two years, which were mainly associated with advanced distal disease, were predominantly not graft related. Most later occlusions were intrinsic; they were caused by distal anastomotic hyperplasia or, in those patients with the largest grafts, the embolization of graft mural thrombi. Revised anastomotic technique and rejection of the largest grafts may ameliorate these problems.