Bypass To the Tibial and Peroneal Arteries Using the Great Saphenous Vein in Situ

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Abstract
In 22 patients with extensive atherosclerotic disease of the lower extermities 24 long bypasses were performed. Main indications for surgery were rest pain and imminent or manifest gangrene. Semiclosed in situ vein technique was used in all except 1 case. Five grafts thrombosed within 2 wk postoperatively, 1 of them was successfully reopened. At discharge 20 grafts were patent, and most of the patients had relief of their ischemic symptoms. After 5 yr, 26% of the long vein grafts were patent. Almost 70% of in situ femoro-popliteal vein grafts were patent. One patient is still living with an open long vein graft 14 yr after surgery. The in situ vein technique is especially suited for long bypasses. The poor results were probably due to extremely advanced atherosclerotic disease and a high percent of small fibrotic veins with a diameter .ltoreq. 3 mm.

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