Original ArticlesFurther experience with an all-autogenous tissue policy for infrainguinal reconstruction☆
Section snippets
Patients and methods
All patients who were first seen with manifestations of chronic peripheral arterial occlusive disease between January 1985 and June 1991 underwent evaluation including study of associated risk factors and documentation of ischemia by noninvasive laboratory studies. Surgical candidates were further studied by preoperative arteriography. Patients with popliteal aneurysms were excluded from review. Duplex ultrasonography was used to assist in the detection of suitable venous conduits in the upper
Results
A total of 585 consecutive autogenous infrainguinal reconstructions were performed on 537 limbs in 448 patients during the study period. The mean age of the patient population was 67 years (range 26 to 91) with current smoking in 331 (57%), hypertension in 332 (57%), coronary disease in 274 (47%), diabetes mellitus in 235 (40%), significant pulmonary disease in 65 (11%), and renal failure in 21 (4%). Mean age (68.3 vs 64.9 years), incidence of diabetes (46% vs 27%), and renal failure (4.1% vs
Discussion
Since it was first used in the late 1940s, autologous GSV bypass has been the standard bearer for infrainguinal revascularization.8, 12, 13, 14 Technical advances including fine suture material, loupe magnification, and modern valvulotomes have facilitated use of smaller diameter veins and popularization of the nonreversed and in situ configurations. This progress has increased the rate of GSV use, available on the ipsilateral or contralateral limb in 76% of all operations and 87% of primary
Acknowledgements
The authors gratefully acknowledge the expert assistance of Ms. Julie Lombara in data analysis.
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Reprint requests: Magruder C. Donaldson, MD, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.