Long-Term Results of In Situ Saphenous Vein Bypass: Analysis of 2058 Cases

Purpose

To evaluate the long-term patency and outcome of patients undergoing infra-inguinal reconstruction using the in situ saphenous vein.

Methods

From 1957 to 1995, 3,148 autogenous vein bypasses were performed of which 2,058 used saphenous vein in situ for their reconstruction. The indications for operation were primarily limb threatening ischemia in 91% (1,875 out of 2,058). 88% of the patients with an intact ipsilateral greater saphenous vein had in situ saphenous vein bypasses completed successfully. Outflow consisted of 69% (1,023) bypasses performed to the infra-popliteal level, and 76% (1,562 of 2,058) were completed using the modified closed in situ technique. Follow-up was completed in 95% of the patients from 0 to 120 months. Groups were divided into long and short bypasses. Long bypasses were considered bypasses that were performed within 10 cm of the femoral bifurcation and 10 cm of the malleolus distally. Those with small veins under 4 mm versus larger veins, open versus closed in situ techniques, diabetics versus non-diabetics, and men versus women were analyzed.

Results

88% of patients with in situ with an intact ipsilateral saphenous vein could have an in situ bypass completed. Primary patency was 84% at 1 year, 72% at 5 years, and 55% at 10 years. Secondary- or primary-assisted patency was 91% at 1 year, 81% at 5 years, and 70% at 10 years. No statistically significant difference in patency was found in long versus short bypasses. There was no statistical difference in patency between larger versus smaller veins as well as no statistical difference in primary and secondary patency based on sex or diabetic status. Limb-salvage rates were 99% at 30 days, 97% at 1 year, 95% at 5 years, and 90% at 10 years.

Conclusions

The infra-inguinal inflow source, length of bypass, specific outflow vessel, or vein diameter do not have a significant effect on immediate or long-term 142bypass performance. These data suggest the in situ saphenous vein is an excellent conduit for femoropopliteal and femoral to infra-geniculate bypasses for limb salvage.