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Norman A. Shoenfeld, MD; Thomas F. O'Donnell, MD; Harry L. Bush, Jr, MD; William C. Mackey, MD; Allan D. Callow, MD, PhD

Arch Surg. 1987;122(8):871-875.

Abstract
• To determine the causes and optimum management of early in situ bypass occlusions, we reviewed our experience of 13 thromboses occurring within the first 30 postoperative days in 148 in situ saphenous vein reconstructions. All early thrombosed bypasses were performed for limb salvage, with 31% of bypasses to the popliteal level and 69% to infrapopliteal vessels. The median time to occlusion was 24 hours. All patients underwent reoperation. Graft failure was due to retained venous valves in 31% of the procedures, other technical problems in 38%, and inadequate outflow in 31%. Reoperative surgery was individualized. In grafts explored for thrombosis, the one-year graft patency rate was 46%, and the limb salvage rate was 54%. Graft patency did not appear to correlate with the presumed cause of Initial graft occlusion. Our results indicate that an aggressive surgical approach is appropriate in early in situ graft thrombosis.

(Arch Surg 1987;122:871-875)

Author Affiliations
From the Department of Surgery, New England Medical Center, Boston (Drs Shoenfeld, O'Donnell, Bush, Mackey, and Callow); Boston Veterans Administration Medical Center (Dr Bush); and Tufts University School of Medicine (Drs Shoenfeld, O'Donnell, Bush, Mackey, and Callow), Boston.

Footnotes
Accepted for publication March 12, 1987.

Read before the 13th Annual Meeting of the New England Society for Vascular Surgery, Dixville Notch, NH, Sept 25, 1986.

Reprint requests to Department of Surgery, Box 259, New England Medical Center, 750 Washington St, Boston, MA 02111 (Dr O'Donnell).

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