WHAT ARE THE BEST ALTERNATIVES IF THE IPSILATERAL GREATER SAPHENOUS VEIN IS UNAVAILABLE OR INADEQUATE?

William M. Abbott

Generally Dacron grafts are used for aorto iliac reconstruction while it is now widely agreed that saphenous vein is the optimum for infra-inguinal operations. Although there are problems associated with any graft material, no other graft even closely rivals the patency performance of saphenous vein in operations going below the knee. These differences become even more apparent the more distal one goes. However, saphenous vein may not always be suitable or available because of previous use or absence after vein stripping years before. The incidence varies in the literature from 10-20% in primary cases, but is, of course, much higher in "redo" cases – the numbers of which are increasing. Thus, surgeons have had to be increasingly creative in situations where there is inadequate ipsilateral long saphenous vein. This has led to the development of techniques to use the short or lesser saphenous veins, veins from the other leg, veins from the arm, and even somewhat controversially, the use of the superficial femoral vein itself. There has been emphasis in many centers on shorter grafting strategies, i.e. a popliteal to distal tibial artery reconstruction. Although there are no prosthetic alternatives whose performance rivals autologous vein, they must always be considered. A separate talk is devoted to that subject. This talk will focus on alternative sources of autogenous vein. At the outset, it must be stated that there is no single strategy which fits all or even most instances. In fact, each case is different and considerable judgment is required to achieve the optimum result for a given patient. The decision making process can be broken down into two parts – 1) amount of available vein and 2) length of bypass needed.

KEY WORDS: greater saphenous vein grafts, alternative autovein grafts.

P. 66-70

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