Lessons learned in adopting the in situ saphenous vein bypass

A 3-year experience with in situ saphenous vein bypasses was analyzed to evaluate the suitability of the conduit, the effect on vein utilization rate, the ease of valve ablation, the incidence of persistent arteriovenous (AV) fistula, the duration of the operation, and the nature of the learning curve to become adept at this technique. From 1981 through 1983, 74 patients underwent 55 femoral-tibial and 23 femoral-popliteal in situ saphenous vein bypasses. The operative indications were threatened limb loss in 76 (97%) and disabling claudication in 2 (3%); 35 of 74 patients (48%) were diabetic. In the last year pulsed Doppler spectrum analysis was added to arteriography for intraoperative graft assessment. For 55 femoral-tibial grafts measured by life-table patency rates at 30 days, only one femoral-popliteal graft failed (1 1/2 years). Complete vein utilization was accomplished in 91% of the bypasses attempted. In 41 of the 78 (51%) grafts, vein diameter was 3.5 mm or less. Operative time decreased with experience. Pulsed Doppler spectral analysis has proved useful for intraoperative graft evaluation. The in situ saphenous vein has become the conduit of choice for infrageniculate bypass.