SHOULD VEIN BE SAVED FOR FUTURE OPERATIONS - A 15-YEAR REVIEW OF INFRAINGUINAL BYPASSES AND THE SUBSEQUENT NEED FOR AUTOGENOUS VEIN

The decision to use prosthetic or autogenous vein as the initial condu it for first-time vascular bypass of the lower extremity depends in pa rt on the likelihood of subsequent need for autogenous conduit for ano ther leg or heart bypass. The true frequency of these later events is not known. To answer this question, we analyzed a database of infraing uinal and coronary artery bypasses (CABG) performed at one institution between January 1980 and July 1995, to determine how many patients re quired subsequent infrainguinal bypass or CABG after their initial leg bypass. Five hundred and seventy-two infrainguinal bypasses were perf ormed on 440 patients (mean age 63.9); average follow-up was 5.6 years . The clinical philosophy favored autogenous vein for first bypass, wh ich was used in 84% of first operations performed during the study per iod while prosthetic material was used in 16%. For patients in which v ein was used for the first operation, and who went on to have a second operation, the use of prosthetic conduit rose from 16% of operations to 27% (p < 0.05). The rate of subsequent CABG after leg bypass was ve ry low, 2% at 5 years, 3% at 10 years. The cumulative probability of r equiring a subsequent infrainguinal bypass was 27% at 5 years, 32% at 10 years. Of these, 46% were ipsilateral and 54% were contralateral. C onsidering only subsequent tibial bypasses (where vein might be consid ered obligatory), the cumulative 5-year rate of subsequent leg bypass was only 13%. Another bypass was most likely to occur within the first 3 years, rarely thereafter. In summary, after primary infrainguinal b ypass, additional procedures using vein may arise in 1/4 to 1/3 of pat ients, mostly in the first 3 years. However, only 13% will definitely need vein for tibial bypass in 5 years, and subsequent CABG is uncommo n.