THE USE OF SPLICED VEIN BYPASSES FOR INFRAINGUINAL ARTERIAL RECONSTRUCTION

Purpose: The use of autogenous vein, whether in situ or excised, for a rterial bypass procedures is well accepted. However, this usually requ ires the presence of a length of good-quality vein of adequate diamete r. In patients lacking sufficient length of vein, two or more pieces o f vein may be spliced together to complete the reconstruction. The eff ect of vein splicing on vein bypass patency is not well studied. Metho ds: Over a 14-year period, 1956 lower extremity revascularizations wer e performed with a single autogenous vein, 1806 in situ and 150 excise d veins. During the same time, 184 bypasses required splicing vein seg ments together, of which 111 were in situ bypass: procedures, which re quired splicing of one or more pieces of excised vein to complete the reconstruction (partial in situ bypass). Seventy-three bypasses were c ompleted with multiple pieces of spliced excised vein. The source for the excised, spliced vein segments was the distal ipsilateral greater saphenous vein (GSV) in 40%, accessory ipsilateral GSV in 8%, contrala teral GSV in 13%, lesser saphenous vein in 28%, and arm vein in 11%. R esults: The 1- and 4-year primary patency rates for the entire spliced vein group were 72% and 45%, with secondary patency rates of 79% and 61%. The 1- and 4-year secondary patency rates of partial in situ bypa sses were 80% and 70%, compared with 91% and 83% for in situ bypasses completed without a spliced segment (p < 0.0001). The 1- and 4-year se condary patency rates were 78% and 67% in the spliced excised vein gro up and 85% and 75% in the single excised vein group (p = not significa nt). The 4-year limb salvage rates were as follows: in situ (96%), par tial in situ (85%), single excised vein (95%), and spliced excised vei n (90%). Conclusions: We conclude that the use of excised vein segment s to complete partial in situ bypasses may be associated with a decrem ent of bypass patency. Use of spliced excised vein segments of good qu ality for arterial bypass can produce acceptable patency rates. Such s pliced autogenous conduits are clearly preferable to prosthetic bypass es for infrageniculate arterial reconstructions. Meticulous technique is a prerequisite for the successful performance of vein-to-vein anast omoses.