ABSTRACT
The first successful femoropopliteal in situ saphenous vein bypass was reported by Hall in 1962.1 Due to this success, more surgeons became interested in this bypass procedure, which was theoretically superior, especially when compared to the use of a reversed vein bypass. There are theoretical advantages physiologically, minimizing endothelial injury by leaving the vasa vasorum intact; mechanically, as a result of the gradual vessel taper and minimal anastomotic discrepancy favourable flow characteristics, reducing haemodynamic injury; and technically, the in situ saphenous vein allowing for greater utilization of small saphenous veins that were previously deemed inadequate. Possible disadvantages related to the technique provide challenges with regards to valve ablation and ligation of venous sidebranches. Although some surgeons still believe the in situ bypass procedure to be more demanding, improved instrumentation, appropriate training and attention to detail, have led to a more acceptable procedure in patients requiring an infrageniculate or crural bypass.
