Sequential in-situ saphenous vein bypass. Early results and technique.

This report summarizes early results with saphenous vein bypass (SVB) utilizing both sequential and in-situ techniques (SIS SVB) in eight limbs requiring limb salvage. SIS SVB was performed to a variety of vessel combinations using "Y" graft, continuous, or vein extension techniques achieving early patency in all limbs, despite pedal arch disease. Postoperatively, there was a significant increase in ankle/brachial Doppler indices (ABI) (P less than 0.001) at dorsal pedal (0.23-0.88) and at posterior tibial (0.32-0.91). Successful isolated popliteal grafting was confirmed by return of phasic Doppler wave forms. All but one limb healed with minimal tissue loss within 1 month of bypass. Preoperative high resolution angiography and clinical Doppler evaluation of saphenous vein anatomy are mandatory to determine candidacy for SIS SVB.