Reverse Vein Graft Research Articles

Distal in situ saphenous vein grafts for limb salvage: Increased operative blood flow and postoperative patency

Early failure remains a major obstacle to successful distal bypass surgery using vein grafts for limb salvage. Thirty distal bypass graft procedures were performed for limb salvage using the in situ technique. Grafts were anastomosed to the distal popliteal artery in 13 patients and to the infrapopliteal artery in 17 patients. Sixteen patients had inadequate saphenous veins for reversed vein grafts. The mean blood flow measured through these grafts (n = 20) was 164 ± 22 ml/min and increased to 278 ± 31 ml/min after administration of 30 mg of papaverine. All grafts were patent at the time of hospital discharge and patients were followed for 1 to 28 months. Life table analysis of the 30 procedures shows a patency of 100 percent at 18 months follow-up. One graft subsequently failed at 22 months. Long-term limb salvage was achieved in 100 percent of the patients in this series. The excellent blood flow through these grafts suggests that the in situ vein graft technique may be more favorable for arterial reconstruction than the reversed vein graft technique. Our preliminary data confirm the observations of Leather et al [3,4], that the rates of vein utilization and graft patency are higher with the in situ technique.

In situ saphenous vein bypass.

Our 20-year results with in situ saphenous vein grafting in the lower extremity were reviewed and compared wih those where reversed saphenous veins were employed. The ten-year patency rates for both types of grafts terminating at the popliteal artery ranged from 41% to 43% and showed no statistical difference. The reversed saphenous vein performed well in the femoropopliteal position because the vein is usually of the same size at the knee as in the groin and thus does not taper when reversed. We have identified from our study specific indications for the in situ operation. These indications are the presence of small or substantially tapering or bifurcating great saphenous veins that otherwise would be unsatisfactory for conventional reversed vein grafting. We believe that the in situ saphenous vein operation should be considered before resorting to prosthetic leg grafts that carry a lower long-term patency, particularly when carried below the knee.

ULNAR ARTERY THROMBOSIS

Forty-six patients with ulnar artery thrombosis were evaluated. A comparison of the results was made between those patients who were treated by sympathectomy and those in whom we attempted to reestablish the blood flow. A reverse vein graft was often used in the latter group. Based on the results of this study, we believe the preferred method of treatment for ulnar artery thrombosis is an attempt at the reestablishment of blood flow.

Reverse saphenous vein graft between ascending aorta and distal right coronary artery in man

Reverse saphenous vein graft between ascending aorta and distal right coronary artery in man

Blood flow in femoropopliteal bypass vein grafts.

BLOOD FLOW through femoropopliteal bypass vein grafts has been measured in a group of patients in an attempt to clarify the interrelationships of flow, angiographic findings, and clinical observations. It was hoped that quantitative blood flow data might provide a reliable prognostic indication for long-range patency. However, we have found that the prognosis must be based on an assessment of multiple factors rather than on any single test or observation. Clinical Material Blood flow was measured in 29 femoropopliteal autogenous vein bypass grafts in 26 patients undergoing operation for occlusive disease in the lower extremities (legs) (Table 1). The indication for operation was claudication in 15 instances, rest pain in three, gangrene in nine, and diffuse aneurysmal change in two. The proximal anastomosis was in the popliteal artery proximal to the joint space in 19 legs and distal to the joint space in ten. Reversed vein grafts were used in

Reverse vein graft tympanoplasty.

AbstractA modification of the vein graft tympanoplasty technique described by Shea and by theTabb is presented. This innovation, designated a reverse vein grafting, has been used by the author in 12 cases and has proved to be advantageous.