External Reinforcement of Varicose Veins with PTFE prosthesis in Infrainguinal Bypass Surgery - Clinical Results

Abstract

Objective: Segmental varicose degeneration of the autogenous greater saphenous vein may limit its use in infrainguinal bypass surgery. Wrapping a PTFE prosthesis around dilated veins has emerged as an option to create externally reinforced vein bypasses. Results regarding graft patency and limb salvage were analyzed. Methods: Between September 1995 and January 2001, 35 infrainguinal bypass operations in 33 patients were performed with greater saphenous veins exhibiting segmental varicose dilatation. Grafts were followed by duplex scan and retrospective analysis of graft patency and limb salvage was performed. Results: One bypass prompted successful revision for early occlusion. Four bypasses required additional reintervention during follow-up. 48 months primary, primary assisted and secondary patency rates were 66 %, 82 % and 82 %, respectively, with a limb salvage rate of 97 %. Duplex scan failed to demonstrate stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. Conclusion: External reinforcement with a PTFE prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation and enables the construction of all autogenous bypasses with promising graft patency and limb salvage.

Varicose veins - vein bypass graft - external reinforcement

References

• 1 Panetta T F, Marin M L, Veith F J. et al . Unsuspected preexisting saphenous vein disease: an unrecognized cause of vein bypass failure.  J Vasc Surg. 1992;  15 102-110
• 2 Faries P L, Logerfo F W, Arora S. et al . Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization.  J Vasc Surg. 2000;  31 1119-1127
• 3 Donaldson M C, Whittemore A D, Mannick J A. Further experience with an all-autogenous tissue policy for infrainguinal reconstruction.  J Vasc Surg. 1993;  18 41-48
• 4 Londrey G L, Ramsey D E, Hodgson K J. et al . Infrapopliteal bypass for severe ischemia: comparison of autogenous vein, composite, and prosthetic grafts.  J Vasc Surg. 1991;  13 631-636
• 5 Kent K C, Whittemore A D, Mannick J A. Short-term and midterm results of an all-autogenous tissue policy for infrainguinal reconstruction.  J Vasc Surg. 1989;  9 107-114
• 6 Rutherford R B, Baker J D, Ernst C. et al . Recommended standards for reports dealing with lower extremity ischemia: revised version.  J Vasc Surg. 1997;  26 517-538
• 7 Kirsch D, Schreiber J, Dienes H P. et al . Alterations of the extracellular matrix of venous walls in varicous veins.  Vasa. 1999;  28 95-99
• 8 Straton C S, Beckmann C F, Jewell E R. Aneurysm formation in distal saphenous vein bypass grafts as a cause of graft failure.  Cardiovasc Intervent Radiol. 1991;  14 167-169
• 9 Bedirhan M A, Onursal E, Barlas C. et al . Unusual complication of Femoropopliteal saphenous vein bypass-aneurysm formation.  Eur J Vasc Surg. 1991;  5 583-586
• 10 Barker S G, Hancock J H, Baskerville P A. True aneurysms of infrainguinal vein bypass grafts: the need for active, not passive management.  Eur J Vasc Endovasc Surg. 1996;  12 378-379
• 11 Loftus I M, McCarthy M J, Lloyd A. et al . Prevalence of true vein graft aneurysms: implications for aneurysm pathogenesis.  J Vasc Surg. 1999;  29 403-408
• 12 Parsonnet V, Shah I H. New stent for support of veins in arterial grafts.  Arch Surg. 1963;  X 696-702
• 13 Deriu G P, Ballotta E, Bonavina L. et al . Great saphenous vein protection in arterial reconstructive surgery.  Eur J Vasc Surg. 1989;  3 253-260
• 14 Melliere D. [Why and when to preserve the saphenous veins of varicose patients to serve as an arterial bypass?].  J Mal Vasc. 1994;  19 216-221
• 15 Melliere D, Le Chevillier B, Kovarsky S. Wrapped autologous greater saphenous vein bypass for severe limb ischemia in patients with varicose veins. Preliminary report.  J Cardiovasc Surg (Torino). 1995;  36 117-120
• 16 Bednarkiwicz M, Vala D, Faidutti B. Use of an internal saphenous varicose vein covered by a polytetrafluoroethylene prosthesis in a femoropopliteal bypass graft [letter].  J Vasc Surg. 1998;  27 588-589
• 17 Soury P, Peillon C, Watelet J. et al . Prosthetic reinforcement of varicose saphenous vein grafts for infrainguinal bypass.  Ann Vasc Surg. 1999;  13 290-293
• 18 Moritz A, Grabenwoger F, Raderer F. et al . Mesh tube - constricted varicose veins used as bypass grafts for infrainguinal arterial reconstruction.  Arch Surg. 1992;  127 416-420
• 19 Moritz A, Grabenwoger F, Wolner E. Mesh tube-calibrated varicose veins for coronary artery bypass grafting.  Ann Thorac Surg. 1994;  57 240-242
• 20 Zurbrugg H R, Hetzer R. The use of biocompound-grafts together with varicose veins. First clinical experience.  J Cardiovasc Surg (Torino). 1996;  37 143-146
• 21 Zurbrugg H R, Wied M, Angelini G D. et al . Reduction of intimal and medial thickening in sheathed vein grafts.  Ann Thorac Surg. 1999;  68 79-83