Compliance changes in in-situ femoropopliteal bypass vein grafts

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Abstract
Changes in wall structure, including neo-intimal proliferation and medial fibrosis, have been implicated as a cause of late occlusion in reversed femoropopliteal vein grafts. These changes can be measured indirectly as a fall in compliance. It has been suggested that long-term patency might be improved by the in situ technique because the nutrient vasa vasorum are left intact and therefore wall structure preserved. We have measured the compliance of 62 in situ vein grafts, with times after operation ranging from 2 days to 6 years, and also compared the compliance changes, in the first 3 months after operation, of 15 undisturbed in situ vein grafts with 15 fully mobilized in situ vein grafts. Compliance was derived non-invasively from the pulse wave velocity using Doppler ultrasound. There was a significant fall in compliance after operation (P < 0·001) and no difference could be found between the undisturbed and mobilized in situ vein grafts (P > 0·1). Histological examination of 6 grafts suggested that the fall in compliance was due to neo-intimal proliferation which still occurred although medialfibrosis was reduced. Any potential improvement in longterm patency rates using the in situ technique must be due to other factors.