In-situ saphenous vein graft for management of critical ischemia of the lower limb

ABSTRACT

Over the last two years, 48 patients with critical chronic ischemia of the lower limbs were treated in the Surgery Department, Ain-Shams University by in situ saphenous vein graft. Additional profundoplasty was done in 12 cases. Early graft thrombosis occurred in three cases, for whom thrombectomy was done under local anesthesia. Late graft failure occurred in 12 cases. Four of these were not symptomatic. Such cases had profundoplasty in addition to the in situ saphenous vein graft. In the remaining 8 occlusions, above-knee amputation was required in 4 cases either because of extensive gangrene or because of failure of the redo of the revascularization by the use of goretex grafts. Thirty-three patients had satisfactory results. Follow up for 1-28 months showed graft patency and freedom from symptoms. Two patients died after hospital discharge, one of them succumbed following a cardiovascular accident. The great advantage of the in situ saphenous vein graft is the feasibility of doing arterial reconstruction at the level of more distal limb arteries as a limb salvage procedure