Superficial femoral-popliteal vein as a conduit for brachiocephalic arterial reconstructions.

Revascularization of brachiocephalic arteries with prosthetic graft offers excellent patency for most reconstructions. For complex brachiocephalic reconstructions, such as redo operations or reconstructions for infection, autogenous conduit may be preferable. Occasionally saphenous vein is inadequate or absent. The purpose of this study was to evaluate the indications and intermediate-term outcomes of superficial femoral-popliteal vein (SFPV) as an alternative conduit for brachiocephalic reconstructions. Over a 6-year period, 71 patients underwent carotid, subclavian, or axillary artery bypass. In 18 (25%) of these reconstruction SFPV was used as the conduit. Ten bypasses (55%) were redo operations. Three bypasses (17%) were performed after failed prosthetic grafts. Three grafts (17%) were required in infected patients. Indications for the use of SFPV included inadequate saphenous vein (n = 13), infection (n = 3), and failed prosthetic bypass (n = 3). Thirty-day mortality was 5.5%. The neurologic event rate was 5.5%. During a mean follow-up of 26 +/- 5 months, there were no graft thromboses or graft infections. Revision-free primary patency was 92% at 48 months. Assisted primary patency was 100%. These data suggest that SFPV is a safe, durable conduit for brachiocephalic reconstructions. SFPV yielded excellent results for a disadvantaged patient population.

Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass.

PURPOSE: Gangrenous bowel, intraabdominal sepsis, and previous failed mesenteric bypass are indications for use of an autogenous conduit for mesenteric arterial reconstruction. Saphenous vein (SV) is often used as the autogenous conduit of choice, but it may be prone to graft stenosis or occlusion. Recent experience with superficial femoral vein (SFV) suggests that it is an excellent alternative conduit for major arterial reconstruction. The purpose of this study was to compare the outcomes of SV and SFV for mesenteric arterial bypass. METHODS: During a 7-year period, 26 patients underwent 43 mesenteric arterial bypass procedures with autogenous conduit. SV was used for 23 bypasses (53%), and SFV was used for 20 bypasses (47%). Indications for revascularization included chronic mesenteric ischemia (n = 15; 58%), acute mesenteric ischemia (n = 9; 35%), and mycotic aneurysm of the paravisceral aorta (n = 2; 7%). Three patients (11%) underwent revascularization with SV grafts and two patients (8%) with SFV grafts after previous failed mesenteric bypass. RESULTS: The 30-day mortality rate was 15%. Three deaths occurred after SV bypass for acute mesenteric ischemia, and one death occurred after a SFV bypass for a ruptured paravisceral mycotic aneurysm. Twenty-two surviving patients were followed for a mean of 31 +/- 6 months. Three of 11 patients (27%) who survived after SV bypass had recurrent mesenteric ischemia develop (acute, n = 1; chronic, n = 2) from graft thrombosis at a mean interval of 32 +/- 22 months after surgery. No patient had recurrent symptoms develop after SFV bypass. One of the three patients with SV graft failure died of acute mesenteric ischemia, and the other two patients underwent successful bypass with SFV. Symptomatic graft failure was significantly more likely to occur in patients receiving SV grafts compared with SFV grafts (P <.05). CONCLUSION: SFV yields acceptable clinical outcomes for mesenteric arterial bypass compared with SV. SFV is a viable alternative to SV when autogenous conduit is indicated for mesenteric arterial reconstruction.