aree scientifiche

0.032). In the calf, at least one great saphenous vein segment suitable for coronary artery bypass grafting is present in 70% of limbs with varicosities and in 89% of limbs with telangiectases.

Conclusions. Ultrasound studies document that varicose veins are limited to accessory saphenous veins.

Great saphenous vein conduits, identified by ultrasonography,

are available in limbs with varicose vein disease.

HARTRANFT CA, Noland S, Kulwicki A, Holden CR, Hartranft T.

Cryopreserved saphenous vein graft in infrainguinal bypass.J Vasc Surg. 2014 Nov;60(5):1291-1296. doi: 10.1016/j.jvs.2014.05.092. Epub 2014 Jul 3.

Abstract

OBJECTIVE: 

Autogenous saphenous vein is the ideal conduit for lower extremity revascularization. Unfortunately, autogenous vein is unavailable in up to 20% of patients. Synthetic grafts provide an alternative; however, their use in distal revascularization has shown varying results. In addition, infected surgical sites preclude their use. Currently, there are limited outcome data for cryopreservedsaphenous vein use in regard to long-term patency and limb salvage rates.

METHODS: 

Cryopreserved saphenous vein allograft use in infrainguinal bypass was studied retrospectively in a community setting. End points included primary patency, limb salvage, and early complications. Records of patients receiving cryopreserved allografts by nine vascular surgeons within one hospital system from 2006 to 2012 were reviewed.

RESULTS: 

Fifty-three patients, mean age 69 years (standard deviation, 12.3; range, 28-90 years), underwent 60 operations. Indications for surgery included limb-threatening ischemia (48%), tissue loss (30%), previous graft or site infection (10%), claudication (7%), or other (5%). The mean follow-up period was 23.9 months (standard deviation, 21.0; range, 0-64 months). Primary patency was maintained in 53% of patients at 1 year and in 22% at 3 years. Limb salvage was achieved in 74% of patients at 1 year and in 70% at 2 years. Thirteen early complications included 8 thromboses, 2 deaths, 2 amputations, and 1 anastomotic disruption. Fifteen patients (28%) underwent additional ipsilateral operations with use of synthetic conduits after initial cryopreserved allografts failed.

CONCLUSIONS: 

Cryopreserved vein allografts displayed poor short-term and long-term patency, whereas limb salvage rates at 1 and 2 years remained acceptable. However, >25% of patients required additional ipsilateral operations with use of synthetic conduits after previous failed cryopreserved allograft use. Our data indicate that cryopreserved vein graft is a suboptimal choice of conduit in a noninfected field.

SAMANO N, Geijer H, Liden M, Fremes S, Bodin L, Souza D.

The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial.

J Thorac Cardiovasc Surg. 2015 Oct;150(4):880-8. doi: 10.1016/j.jtcvs.2015.07.027. Epub 2015 Jul 15.

Abstract

OBJECTIVES:This study investigates whether the no-touch (NT) vein graft, at a mean time of 16 years, maintains a significantly higher patency rate than conventional (C) vein grafts and still has patency comparable to that of the left internal thoracic artery (LITA).

METHODS:A total of 156 patients accepted for coronary artery bypass grafting were randomly allocated to 1 of 3 groups. In the C group, the saphenous vein (SV) was stripped and distended. In the intermediate group, the SV was stripped but not distended. In the NT group, the SV was neither stripped nor distended, but rather harvested with a fat pedicle. This study is an angiographic follow-up of the C and NT groups, at a mean time of 16 years postoperatively.

RESULTS:Fifty-four patients were included (C group = 27; NT group = 27). In all, 72 and 75 vein grafts were completed in groups C and NT, respectively. Crude SV graft patency was 64% in the C group versus 83% in the NT group (P = .03), which was similar to the patency of the LITA (88%). The harvesting technique had a major impact on the patency with a hazard ratio for occlusion of 1.83 for the C group (P = .04).

CONCLUSIONS:Harvesting the SV with the NT technique conferred, at a mean time of 16 years, a significantly higher patency than the conventional technique that was still comparable to that of the LITA.

VASCULAR AND ENDOVASCULAR TECHNIQUES

Peter F. Lawrence, MD, SECTION EDITOR

MAHER FATTOUM, Stefan Kennel, MD,Peter Knez, MD,Thomas Schmitz-Rixen, MD, PhD, Hazem Khout, MD, and Matthias H. Tenholt, Mannheim, Darmstadt, and Frankfurt, Germany; and Leicester,

United Kingdom: “Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein”

J Vasc Surg 2016;64:819-23.

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