Infrainguinal arterial reconstruction with non-reversed autologous vein after angioscopy guided valvulotomy ex situ.

Abstract

The advantages of in situ autologous vein grafts for long infrainguinal arterial reconstructions are the tapered conduit, minimising size mismatch at proximal and distal anastomoses, and the possibility of using small sized veins with good results. Unfortunately, in about 30% of legs the ipsilateral saphenous vein is inadequate rendering in situ bypass grafting impossible. To profit from a valveless autologous vein graft in these cases we routinely performed ex situ valvulotomy after harvesting the contralateral saphenous vein or good quality segments of the ipsilateral saphenous vein. The ex situ valvulotomy was performed under angioscopic guidance using a flushing-type Mill's valvulotome. Fifty non reversed grafts in 46 patients entered a prospective surveillance program. Primary and primary-assisted patency rates at 2 years were 68% and 82% respectively, early graft thrombosis 2%, late stenosis 8% and major amputation rate with a patent graft 6%. No technique related problems were noticed. Angioscopy guided valvulotomy was safe and simple and allowed good quality control of the veins. The presented results in this study are comparable to other recently reported series of in situ bypass. The clinical use of small flexible endoscopes allows a safe and atraumatic valvulotomy and simultaneous quality control of autologous vein grafts.