Comparison of initial limb salvage in 98 consecutive patients with either reversed autogenous or in situ vein bypass graft procedures.

A retrospective review of 98 consecutive patients undergoing femoropopliteal or distal bypass procedures was conducted to determine whether in situ bypass grafting offers statistically significant initial limb salvage over reversed autogenous techniques. Over a 40 month period, 98 consecutive patients received either in situ or reversed autogenous vein grafts to effect limb salvage. The groups were similar in incidences of diabetes and previous myocardial infarctions, as well as in site of distal anastomosis (beneath the tibial peroneal trunk in more than 80 percent). The in situ vein graft group had an overall limb salvage rate of 92 percent with an 88 percent cumulative patency rate at 4 to 18 month follow-up, whereas the reversed autogenous vein graft group had a limb salvage rate of 86 percent with a 79 percent cumulative patency rate at up to 18 months. Results after 30 days showed 47 patients had improvement and 3 patients (6 percent) had died in the in situ vein graft group. In the reversed autogenous vein graft group, 44 patients improved, 4 did not improve and required amputations, and 2 (1 percent) died. Our study supports the use of in situ vein bypass grafting for limb salvage.