Comparison of in-situ and reversed saphenous vein grafts for infrageniculate bypass.

Current controversy surrounding in-situ and reversed saphenous vein grafts prompted a review of 161 procedures performed between 1982 and 1987. Analysis was based on objective criteria recommended by the Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) Committee on Reporting Standards. There were 92 in-situ bypasses, 42 to the popliteal artery below the knee, and 50 to tibial vessels; of 69 reversed vein grafts, the comparable figures were 51 and 18. Sixty-seven in-situ and 43 reversed grafts were done for foot salvage. The overall primary patency rate for in-situ grafts was 81.1% at 30 days, 77.0% at 1 year, 74.7% at 3 years and 59.8% at 5 years; corresponding reversed vein patency rates were 85.2%, 76.8%, 67.0% and 42.3%. Patency rates for foot salvage for in-situ grafts were 81.7% at 1 month, 75.9% at 1 year and 72.6% at 3 years, and for reversed vein grafts 78.6%, 70.3% and 66.5%. Secondary patency rates were 72.8% at 3 years for in-situ vein and 67.2% for reversed vein; the foot-salvage rate at 3 years was 91.0% with in-situ vein and 78.9% with reversed vein. The study demonstrated no statistically significant difference between in-situ and reversed saphenous vein bypass for infrageniculate reconstruction, regardless of the distal anastomotic site or severity of disease. Although a trend favouring the in-situ technique was noted, particularly at the tibial level, longer follow-up and a prospective randomized trial is needed to evaluate this.