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ARTICLES ABOUT SPARING INCOMPETENT SAPHENOUS TRUNK AND USE FOR ARTERIAL

BY-PASS

LOFGREN EP. In Bergan JJ, Yao JST (eds). Surgery of the veins 1985: 285-99

2-3% of patients treated for varicose veins will need an arterial by-pass  

SCARANO:  MINERVA ANGIOLOGICA 1993; 18 (Suppl 1 al N° 4) : 93 – 5

A venous pathology assumed ad relevant was present in 32% of patients undergoing a generic arterial by pass, this highlights the importance of the phenomenon.

WIENERT V. : Chez un malade variquex quel est le risque de développer un oblitératione artérielle périphérique ?

Phlébologie 1998, 51, 269-271

Abstract:

Aftere having shown the significant general frequency of varices taking both sexes together, the author demonstrates that on the other hand the frequency of peripheral arterial diseases is much lower up to the age of 50 years but then rises to attain more than 10% among the senior citizen population. He deplores the non-existence of arterial varices-affected concomitant epidemiological studies but by confronting the statistical data concludes that, in the different age groups of a given population, at the most 10% of varicose patients suffer peripheral arterial disease. This 10% represents an average.

SESSA C. et Al. : La saphène patologique, un greffon potentiel dans la chirurgie de sauvetage de membre

Phlébologie 1998, 51, N°3, : 313-319

ABSTRAC

The greater saphenous vein is the optimal conduit for distal lower extremity arterial revascularisation. Unfortunately, saphenous vein of sufficient length. or size is not always available or is inadequate in about 10 to 40 % of the cases. The outcome of venous grafts is mainly based on the diameter and the quality of the vein. These can be determined by preoperative duplex scanning, by intraoperative gross appearance of the vein, by angioscopy and biopsy. Postphlebitic diseases often preclude use of the vein, while diffused or segmental venous dilatations can be treated with resection or external wrapping achieving good results. Bypasses performed with postphlebitic recanalized, calcified and thick-walled veins fare poorly with a patency rate of 32 % at 30 months and a early failure rate of 20%. Because diseased saphenous vein carry a high risk of failure alternate conduit should be used. Alternate conduits include other autogenous veins, composite graft or prosthetic graft with adjunctive technique (patch or cuff). Venous or arterial allografts provide a suitable alternative while waiting for the development of new graft and the improvement of endothelial seeding of prosthetic grafts. The decision to use a diseased saphenous vein is based upon the surgeon’s convictions and the availability of other arterial substitutes.

SESSA C. et Al. : Quel devenir des greffons venineux issus d’une veine variqueuse (Revu de la littérature)

Phlébologie 1998, 51, N°3, : 343-347

ABSTRAC

The varicose long saphenous vein (LSV) has often been discarted as an arterial conduit for peripheral revascularisations because deemed to carry a high risk of rupture and long term deteriorations. About 80 % ofthe patients presenting with varicosities have a fairly normal or slightly dilated LSV and nearly 3 % or these patients will need an arterial revascularisation: Segmental venous dilatations can be resected, while diffuse varicosities can be wrapped with a mesh-tube prosthesis allowing use of vein up to 8 mm in size. Experimental studies have shown that perivenous meshes preserve histological and endothelial functions of varicose vein, decrease myo-intimal hyperplasia and atherosclerosis in the vein grafts. The fewer publications in the literature have reported that varicose veins wrapped with prosthetic graft achieve good results in lower limb revascularisations without complications and long term deteriorations. Thus the potential use of varicose veins should lead to preserve all LSV suitable for arterial bypass in patients with varicosities that present risk factors of atherosclerosis. The decision of using a diseased saphenous vein is based upon the surgeon’s convictions and the availability of other arterial substitutes.

MELLIERE D,Cales B,Martin-Jonathan C,Schadeck M

Necessity of reconciling the objectives of the treatment of varices and arterial surgery. Practical consequences

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