Mesh tube--constricted varicose veins used as bypass grafts for infrainguinal arterial reconstruction
A. Moritz, F. Grabenwoger, F. Raderer, H. Ptakovsky, M. Staudacher, H. Magometschnigg, R. Ullrich and E. Wolner
Second University Surgery Clinic, University of Vienna, Austria.
Varicose veins are generally deemed inappropriate graft material for
arterial reconstructions despite their physiologic flow surface because of
their large and irregular caliber. Size reduction by threading such veins
in constricting tubes may create bypass grafts of suitable caliber as long
as redundant wall material does not cause stenoses. Sixteen human varicose
veins (mean +/- SD, 13 +/- 3 mm diameter) obtained after stripping
operations were inserted into Dacron mesh tubes of 6 mm internal diameter.
Paraffin casts of the distended veins showed a size reduction of 6.9 +/-
2.6 mm. Wall material formed folds in only two veins. In both cases,
diameter reduction was more than 10 mm. However, the folds did not result
in significant stenoses. Mesh-constricted varicose veins were used as
bypass material in 11 infrainguinal arterial reconstructions. All
externally supported segments showed satisfactory size reduction without
stenoses or folds. One graft occluded 2 months after surgery. Two patients
had to undergo reoperation after 2 and 16 months, respectively. None of the
complications could be attributed to the constriction of veins. The
remaining grafts are patent and functional after a mean of 17 months
(range, 6 to 42 months). Considerable size reduction by external wrapping
of varicose veins is possible without adverse side effects. Such
constricted veins were used successfully as bypass grafts for infrainguinal
arterial reconstructions.
