Lessons from initial experience with the in situ saphenous vein graft.

A policy of preference for the in situ saphenous vein was adopted for all patients requiring bypass grafting below the knee. In an initial series of 25 operations, technical complications occurred in eight cases (32%), including venographic extravasation, vein injury during valve lysis, and early graft occlusions due to incomplete valve lysis and routing under tension past the hamstring tendons. Early loss of tibial outflow vessels occurred twice, with retrieval of embolic debris possibly shed from the graft. In spite of these events, at an average follow-up of ten months, 21 grafts were open (84% patency). Two occlusions occurred in patients who suffered operative complications, and another graft was lost after rethrombosis of a donor axillobifemoral prosthesis. Acceptable patency in spite of technical mishaps early in my experience encourages continued efforts to master the in situ method.