[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.205.111.118. Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
July 1985

In Situ Femoropopliteal and Infrapopliteal BypassTwo-Year Experience

Author Affiliations

From the Departments of Surgery, Rhode Island Hospital (Dr Carney), Veterans Administration Medical Center (Dr Balko), and St Joseph's Hospital and Roger Williams Hospital (Dr Barrett), Providence, RI.

Arch Surg. 1985;120(7):812-816. doi:10.1001/archsurg.1985.01390310050011
Abstract

• We describe 83 in situ femoropopliteal and infrapopliteal artery bypass grafts. The in situ technique involved the valve incision method using scissors, the valvulotome (Leather), and a modified valve cutter (Hall). Arteriovenous fistulae were detected intraoperatively by angiography and/or the Doppler method and ligated. The operative indications were rest pain, ulcer, and gangrene in 88% of cases, and claudication in 7.2%. The mean preoperative ankle pressure was 61.3 mm Hg and the ankle-brachial index was 0.43. The mean postoperative ankle pressure was 125.3 mm Hg and the ankle-brachial index was 0.97. The vein utilization rate was 96%. One-year patency for popliteal anastomoses was 85.7%, for peroneal anastomoses it was 100%, and for infrapopliteal anastomoses it was 89.6%. The data suggest that the practicing vascular surgeon can adopt the in situ technique and can expect high graft patency rates even in limb salvage situations with poor distal outflow.

(Arch Surg 1985;120:812-816)

References
1.
Leather RP, Shah DM, Corson JD, et al:  Instrumental evolution of the valve incision method of in situ saphenous vein bypass . J Vasc Surg 1984;1:113-123.Article
2.
Hall KV:  The great saphenous vein used in situ as an arterial shunt after extirpation of the vein valves . Surgery 1962;51:492-495.
3.
Connolly JE, Stemmer EA:  The nonreversed saphenous vein bypass for femoral-popliteal occlusive disease . Surgery 1970;68:602-609.
4.
Barner HB, Judd DR, Kaiser GC, et al:  Late failure of arterialized in situ saphenous vein . Arch Surg 1969;99:781-786.Article
5.
May AG, DeWeese JA, Rob CG:  Arterialized in situ saphenous vein . Arch Surg 1965;91:743-750.Article
6.
Connolly JE, Kwaan JHM:  In situ saphenous vein bypass . Arch Surg 1982;117:1551-1557.Article
7.
Leather RP, Powers SR, Karmody AM:  A reappraisal of the in situ saphenous vein arterial bypass: Its use in limb salvage . Surgery 1979;86: 453-461.
8.
Leather RP, Shah DM, Karmody AM:  Infrapopliteal arterial bypass for limb salvage: Increased patency and utilization of the saphenous vein used 'in situ.' Surgery 1981;90:1000-1008.
9.
Bush HL, Corey CA, Nabseth DC:  Distal in situ saphenous vein grafts for limb salvage . Am J Surg 1983;145:542-548.Article
10.
LiCalzi LK, Stansel HC:  Failure of autogenous reversed saphenous vein femoropopliteal grafting: Pathophysiology and prevention . Surgery 1982;91:352-358.
11.
Szilagyi DE, Hageman JH, Smith RF, et al:  Autogenous vein grafting in femoropopliteal atherosclerosis: The limits of its effectiveness . Surgery 1979;86:836-851.
12.
Darling RC, Linton RR:  Durability of femoropopliteal reconstructions . Am J Surg 1972;112:472-479.Article
13.
Reichle FA, Tyson RR:  Comparison of long-term results of 364 femoropopliteal or femorotibial bypasses for revascularization of severely ischemic lower extremities . Ann Surg 1975;182:449-455.Article
14.
Imparato AM, Kim GE, Madayag M, et al:  The results of tibial artery reconstruction procedures . Surg Gynecol Obstet 1974;138:33-38.
15.
Bush HL Jr, Graber JN, Jakubowski JA, et al:  Favorable balance of prostacyclin and thromboxane A2 improves early patency of human in situ vein grafts . J Vase Surg 1984;1:149-159.
16.
Buchbinder D, Singh JK, Karmody AM, et al:  Comparison of patency rate and structural changes of in situ and reversed vein arterial bypass . J Surg Res 1981;30:213-222.Article
×