Original Articles from the International Society for Cardiovascular Surgery, North American ChapterProspective randomized multicenter comparison of in situ and reversed vein infrapopliteal bypasses☆,☆☆
Section snippets
Methods
All three centers had considerable interest and experience in the performance of infrainguinal bypass procedures by use of both reversed and in situ vein grafts.3, 17, 23 All six participating surgeons were adept in the performance of both techniques, and all agreed to the following standard protocol for the evaluation, randomization, operative care, and postoperative follow-up of their patients undergoing infrapopliteal bypass. Appropriate approval of this protocol was obtained from the
Excluded or withdrawn patients
Seventy-four (37%) of the 199 candidates for randomization (Table I) were excluded before randomization or withdrawn after randomization because the vein was unsuitable for use because it was absent, too small (<2.5 mm in MDD), fibrotic, or had an intraluminal obstruction to the passage of a soft catheter. Fiftynine patients (30%) underwent a bypass with a contralateral saphenous or another ectopic vein, and 15 (7%) received a prosthetic polytetrafluoroethylene graft.
Clinical characteristics of patients and vein grafts in the randomized group
Characteristics of the
Discussion
Infrainguinal reconstructive arterial surgery for limb salvage is now widely accepted and practiced.1, 2 Operability rates and limb salvage rates have increased dramatically.3 In addition, as techniques for performing infrainguinal bypasses in general and infrapopliteal bypasses in particular have improved, the patency rates have increased. Important contributions to these improved results have been the introduction of fine instruments, meticulous techniques, and recognition of the frequent
References (33)
- et al.
Prospective multicentered randomized comparison of autologous saphenous vein (ASV) and expanded polytetrafluoroethylene (PTFE) grafts in infrainguinal arterial reconstructions
J Vasc Surg
(1986) - et al.
A comparison of in situ and reversed saphenous vein grafts for infrainguinal reconstruction
J Vasc Surg
(1987) - et al.
Distal in situ saphenous vein grafts for limb salvage: increased operative blood flow and postoperative patency
Am J Surg
(1983) - et al.
Durability of the in situ saphenous vein arterial bypass: a comparison of primary and secondary patency
J Vasc Surg
(1987) - et al.
Present status of reversed vein bypass for lower extremity revascularization
J Vasc Surg
(1986) - et al.
Present status of reversed vein bypass grafting: five-year results of a modern series
J Vasc Surg
(1990) - et al.
Improved patency in reversed femoral-infrapopliteal autogenous vein grafts by early detection and treatment of the failing graft
J Vasc Surg
(1987) - et al.
Does the in situ technique improve flow characteristics in femoropopliteal bypass?
J Vasc Surg
(1986) - et al.
Intimal integrity and fibrinolytic potential of reversed and in situ vein grafts
J Vasc Surg
(1987) - et al.
Instrumental evolution of the valve incision method of in situ saphenous vein bypass
J Vasc Surg
(1984)
Influence of vein size (diameter) on infrapopliteal reversed vein graft patency
J Vasc Surg
The reoperative potential of infrainguinal bypass: long-term limb and patient survival
J Vasc Surg
Comparison of patency rate and structural changes of in situ and reversed vein arterial bypass
J Surg Res
Changes in vein grafts following aorto-coronary bypass induced by pressure and ischemia
J Thorac Cardiovasc Surg
Effect of arterial reconstruction on limb salvage: a ten-year appraisal
Arch Surg
Progress in limb salvage by reconstructive arterial surgery combined with new or improved adjunctive procedures
Ann Surg
Cited by (109)
Endovascular treatment of an aneurysmal vein graft twenty-six years after infrainguinal revascularization
2023, Annals of Vascular Surgery - Brief Reports and InnovationsNon-reversed and Reversed Great Saphenous Vein Graft Configurations Offer Comparable Early Outcomes in Patients Undergoing Infrainguinal Bypass
2022, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :The reversed vein bypass uses mobilisation of the entire length of the GSV, which is subsequently reversed in configuration to allow the passage of flow through valves. Many studies have evaluated outcomes of in situ and reversed vein bypasses with mixed results regarding the superiority of either technique.8–15 First described by Batson and Sottiurai in 1985, the non-reversed, transposed vein bypass combines two important attributes of both reversed and in situ techniques.16
Systematic review and meta-analysis of saphenous vein harvesting and grafting for lower extremity arterial bypass
2021, Journal of Vascular SurgeryCitation Excerpt :These studies reported no significant differences in the patency of LEAB between continuous incision harvesting and skip incision harvesting (Peto OR, 0.93; 95% CI, 0.83-1.04; P = .20; I2 = 94%). A total of 20 studies reported data on reversed vs in situ bypass grafting (Table III).13,14,37,40-55 We did not find evidence of a difference between reversed and in situ grafting in the mortality rate (RR, 0.91; 95% CI, 0.45-1.87; P = .80; I2 = 0%) or wound complications (RR, 0.91; 95% CI, 0.45-1.82; P = .80; I2 = 65%).
Peripheral arterial disease and bypass surgery in the diabetic lower limb
2013, Medical Clinics of North AmericaReconstructive Surgery for Peripheral Artery Disease
2013, Vascular Medicine: A Companion to Braunwald's Heart Disease: Second EditionBasic data related to surgical infrainguinal revascularization procedures: A twenty year update
2011, Annals of Vascular Surgery
- ☆
Supported in part by the Manning Foundation, the Anna S. Brown Trust, the Hunter Surgical Research Fund, and the New York Institute for Vascular Studies.
- ☆☆
Reprint requests: Frank J. Veith, MD, 111 E 210 St., New York, NY 10467.