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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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PERIPHERAL ARTERIES  20 YEARS EVC: MANAGEMENT OF ARTERIAL DISEASES


The Journal of Cardiovascular Surgery 2016 Aprile;57(2):292-301

lingua: Inglese

Vein harvesting and techniques for infrainguinal bypass

Anders ALBÄCK , Eva SAARINEN, Maarit VENERMO

Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland


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In order to achieve good long term results after bypass surgery, alongside with good inflow and outflow arteries, the bypass graft material also has an important role. The best patency and limb salvage rates are achieved with autologous vein. If great saphenous vein is not available, acceptable long-term results can be achieved with arm veins and lesser saphenous vein. The quality and size of the vein are important. A small-caliber vein, increased wall thickness, postphlebitic changes and varicosities are associated with a risk of early failure. Preoperative vein mapping with ultrasound reduces readmissions and postoperative surgical site infections. During the mapping, the vein to be used and its main tributaries are marked with a permanent marker pen. To reduce wound complication rates we recommend bridged incisions in vein harvesting. Endoscopic vein harvesting seems to have no benefit compared to open techniques in lower limb bypasses, and has been associated with higher risk of primary patency loss at one year. With deep tunneling of the graft the problems caused by wound infection can be avoided.

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anders.alback@hus.fi