Lessons from initial experience with the in situ saphenous vein graft
M. C. Donaldson
A policy of preference for the in situ saphenous vein was adopted for all
patients requiring bypass grafting below the knee. In an initial series of
25 operations, technical complications occurred in eight cases (32%),
including venographic extravasation, vein injury during valve lysis, and
early graft occlusions due to incomplete valve lysis and routing under
tension past the hamstring tendons. Early loss of tibial outflow vessels
occurred twice, with retrieval of embolic debris possibly shed from the
graft. In spite of these events, at an average follow-up of ten months, 21
grafts were open (84% patency). Two occlusions occurred in patients who
suffered operative complications, and another graft was lost after
rethrombosis of a donor axillobifemoral prosthesis. Acceptable patency in
spite of technical mishaps early in my experience encourages continued
efforts to master the in situ method.
