The myth of the in situ graft: Superiority in infrainguinal bypass surgery?

Objectives: to compare the clinical outcome of in situ and reversed bypass grafting. Design: multicentre, prospective, non-randomised study. Patients and methods: five-hundred patients with an in situ graft and 955 p atients with a reversed graft were compared regarding graft occlusion, the need for graft revision, and limb salvage. Results: two-year assisted primary patency of femoropopliteal bypass proced ures was 82% for in situ and 82% for reversed grafts. The corresponding haz ard ratio (HR) for occlusion was 1.27 (95% CI 0.91-1.77). The 2-year assist ed primary patency of femorocrural bypass procedures was 69% for in situ vs . 70% for reversed grafts. The corresponding HR was 1.13 (95% CI 0.73-1.75) . Adjustment for relevant baseline variables did not change the results. Mo re reinterventions were needed to maintain integrity and patency of the in situ graft especially in crural bypasses. No differences in limb salvage ra tes were seen. Conclusions: reversed and in situ vein grafts have similar patency and limb salvage rates for both femoropopliteal and femorocrural bypass procedures. The in situ graft needs more secondary interventions.