VENOUS STASIS COMPLICATIONS OF THE USE OF THE SUPERFICIAL FEMORAL ANDPOPLITEAL VEINS FOR LOWER-EXTREMITY BYPASS

Purpose: The widely accepted durability of autogenous vein for infrain guinal arterial bypass has led the authors to use the superficial femo ral and popliteal vein in selected cases. The results of this experien ce are presented. Methods: From January through December 199 1, during which 92 lower extremity bypass procedures were performed, deep vein bypass was attempted in seven patients (three femoral-popliteal grafts , two femoral-peroneal grafts, one femoral-deep femoral bypass, and on e popliteal-posterior tibial bypass). In all cases the saphenous vein was absent or inadequate for use as a bypass conduit. The superficial femoral vein was harvested to below the knee in five patients. Results : At last follow-up six of seven patients had patent grafts with relie f of their original symptoms. All the procedures were complicated by v enous stasis; acute postoperative phlegmasia developed in two cases. I n one of these cases the limb was salvaged by below-knee fasciotomy an d deep venous bypass (distal popliteal vein to common femoral vein wit h polytetrafluoroethylene). In the other case an above-knee amputation was required. Of the five remaining patients three had moderate venou s stasis edema unresponsive to limb elevation and compression stocking s after operation, and two have had resolution of minimal postoperativ e venous stasis with simple limb elevation. All cases of severe and mo derate venous stasis occurred in patients with popliteal vein harvest to below the knee. Conclusions: The authors conclude that the use of t he deep veins of the lower extremity for bypass is effective but is as sociated with a significant increase incidence of venous stasis edema. Two instances of phlegmasia were associated with popliteal vein harve st below the knee, and the authors caution against harvest of the popl iteal vein to this level.