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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Giornale Italiano di Chirurgia Vascolare 2001 June;8(2):97-110

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English, Italian

Lesser Saphenous Vein (LSV) in distal revascularisation for limb salvage

Spinelli F., Mirenda F., Mandolfino T., La Spada M., D’Alfonso M., Roscitano G., Stilo F.

From the Institute of Thoracic and Cardiovascular Surgery University of Messina, Messina, Italy


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Background. The ­study ­aimed to eval­u­ate the pos­sibil­ity of revas­cu­lar­is­ing the extrem­ities ­using the LSV in the ­absence of the great­er saph­e­nous ­vein (GSV).
Methods. A ­total of 482 dis­tal revas­cu­lar­isa­tions ­were per­formed ­between 1984 and 1998 for crit­i­cal leg ische­mia in 454 ­patients. LSV was ­used in 77 cas­es in ­which GSV was not avail­able. GSV was not ­present for the fol­low­ing rea­sons: pre­vi­ous aor­to­cor­o­nary ­bypass in 22 cas­es; ear­li­er revas­cu­lar­isa­tion of extrem­ities ­failed in 36 cas­es; strip­ping in 5 cas­es; var­i­coph­le­bitis in 3 cas­es; par­tial or ­total inad­e­qua­cy of GSV in 11 cas­es. The indi­ca­tions for ther­a­py in ­this ­group of ­patients ­were: rest­ing ­pain in 3 cas­es, troph­ic dis­or­ders in 20 cas­es, gan­grene of the ­toes in 48 cas­es and gan­grene of the ­heel in 6 cas­es. The fol­low­ing tech­niques ­were ­used: exclu­sive ­bypass ­with LSV in 34 cas­es; com­pound ­bypass ­with ­PTFE in 5 cas­es; sequen­tial ­bypass ­below oth­er ­vein ­grafts or pros­the­ses in 18 cas­es; sec­on­dary ­repair or exten­sion of ­bypass ­using LSV in 20 cas­es. Contralateral LSV was not ­used in any ­case.
Results. The ­results includ­ed oper­at­ing mor­tal­ity in 1 ­case, ­acute arte­ri­al occlu­sion in 10 cas­es (13%), ampu­ta­tion in 3 cas­es (3.9%), ­local com­pli­ca­tions in 4 cas­es (5.2%) in the ­form of cuta­ne­ous necro­sis (Achilles ten­don and ­calf). Late ­results: 5 bypass­es ­became occlud­ed dur­ing the post­op­er­a­tive peri­od and 27 ­patients ­died ­from oth­er caus­es (ischem­ic car­di­om­yo­pa­thy, ­stroke, etc.).
Conclusions. LSV is an ade­quate arte­ri­al sub­sti­tute ­which can be ­used if GSV is not avail­able, achiev­ing a slight­ly low­er paten­cy ­rate and a high­er cuta­ne­ous mor­bid­ity and ena­bling the ­venous resourc­es of the con­tra­lat­er­al ­limb to be pre­served.

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