Martin L. Schulman

A saphenous alternative: Preferential use of superficial femoral and popliteal veins as femoropopliteal bypass grafts☆

Our experience with 100 superficial femoral and popliteal veins over a 12 year period has established a firm basis for their preferential use as femoropopliteal bypass grafts. Deep leg veins are currently used in two thirds of primary femoropopliteal bypass candidates. Groups identifiable preoperatively in whom results have been inferior include patients with excessively large grafts, black patients, and those with extremely poor runoff. Patients who will develop distal anastomotic hyperplasia, a fourth problem group, cannot be detected preoperatively but can be diagnosed and managed effectively. Disadvantages of superficial femoral and popliteal vein use include longer and more traumatic operations, increased early limb swelling, and the need for preoperative venography and postoperative arteriography to achieve optimum results. The most important advantage of preferential deep leg vein use is the high patency rate at 2 years with the expectation, already being realized, of significantly reduced intrinsic graft failures in the later years. Saphenous vein preservation constitutes a major additional bonus.

DEEP LEG VEINS AS FEMOROPOPLITEAL BYPASS GRAFTS

ConclusionOur extensive experience indicates that resection of normal superficial femoral and popliteal veins is free of significant late morbidity. Adequate evidence to the contrary has never been presented. Our 5-year patency rates using deep leg veins equal or surpass the best results ever reported with saphenous veins. Erroneous presentation of our work, as exemplified by the comments of Bergan and associates, tends to delay the acceptance of a major arterial graft source. Deep leg vein grafts represent an important advance in arterial reconstructive surgery, and we are confident that future reports by other groups will confirm the high patency rates and lack of significant late morbidity in our reports [36, 37, 43] and that of Noppeney [1].