Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein.

Abstract

This study was conducted to determine whether it was feasible to increase the diameter of smaller great saphenous veins (GSVs) in preparation for possible bypass and whether such a conditioned conduit could be used with reasonable patency. Twenty-five patients (26 cases: 24 peripheral arterial occlusive disease, 2 popliteal aneurysms) with GSV diameters between 2 and 3 mm underwent in situ GSV valvulotomy and were observed for 3 months. After GSV dilation to >3 mm for below-knee revascularization and >3.5 mm for above-knee revascularization, arterial bypass surgery was performed with the valvulotomized GSV. Adequate GSV diameter was reached in 20 cases (77%). Arterial bypass surgery using valvulotomized GSV was performed an average 131 days (range, 64-373 days) after valvulotomy in 16 patients (61.5%). No deaths, amputations, or aneurysms occurred 2 years after surgery. At 1 and 2 years, primary patency was 81% ± 9.8% and 69% ± 11.8%, respectively, and secondary patency was 87% ± 8.3% and 75% ± 11%, respectively. Valvulotomy can be used to expand small-diameter GSV for lower extremity arterial bypass.