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The transition to "in situ" vein bypass grafts.

In situ saphenous vein bypass grafts were used to revascularize 109 lower extremities in 99 patients during 1984. Of those, 102 were single length grafts carried out in 53 males and 39 females with an average age of 69 and 75 years old, respectively. The expected associated risk factors were observed: smoking in 69 per cent, hypertension in 57 per cent, heart disease in 52 per cent and diabetes in 31 per cent of the patients. Grafts were performed for limb salvage in 71 patients, claudication in 30 and aneurysm in one. Single length grafts originated from the common (47), superficial (27), deep femoral (18) or popliteal (four) arteries or proximal Dacron (polyester) grafts (six); 93 per cent of the grafts were to an infrageniculate target site, while 44 per cent extended to an infrapopliteal artery and 7 per cent to the ankle. Operating time including completion angiography, which was done in every instance, was comparable to that with reversed vein grafts. The patency rate at one year was 96 per cent or 87 per cent when claudication or limb salvage was the indication for operation, and 92 per cent or 86 per cent when the distal anastomosis was to a popliteal or infrapopliteal artery. Limb salvage rates were 97 per cent at one month and 91 per cent at one year. All five amputations occurred in patients receiving infrapopliteal grafts for gangrene. The survival rate was 97 per cent at one month and 85 per cent at one year.