ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 1998 August;39(4):405-11

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Superficial femoral vein in arterial reconstruction for limb salvage: outcome and fate of venous circulation

Wozniak G., Gortz H.*, Akinturk H., Dapper F., Hehrlein F., Alemany J.*

From the Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen * Department of Vascular Surgery, Knappschafts-Krankenhaus, Bottrop, Germany

Back­ground. In ­some par­tic­ular ­cases in vas­cular sur­gery it is man­da­tory to per­form arte­rial recon­struc­tion ­using autol­o­gous ­graft. ­Since 1985, we ­have ­been ­using the super­fi­cial ­femoral ­vein for arte­rial sub­sti­tute in the ­case of ­limb sal­vage, ­when ­another autol­o­gous ­vein has not ­been avail­able. We ­made a pros­pec­tive inves­ti­ga­tion on 32 ­patients ­over a ­mean ­period of 24.5±12.1 ­months (1 to 48 ­months) to eval­uate the use­ful­ness of super­fi­cial ­femoral ­vein (SFV) for ­distal arte­rial recon­struc­tive sur­gery and to objec­tify the ­fate of ­venous cir­cu­la­tion of the ­limb ­after ­removal of ­this ­vein.
­Methods. ­There ­were 20 ­male and 12 ­female ­patients aver­aging 64.3±10.3 ­years, who under­went ­crural arte­rial recon­struc­tive sur­gery ­using the com­posite tech­nique (­PTFE and SFV). All ­grafts had ­been ­placed sub­cu­ta­ne­ously in lat­eral to ­knee posi­tion. ­Mean ­length of ­removed super­fi­cial ­femoral ­vein was 13.2±9.4 cm.
­Results. In 6 ­patients (18.7%), we ­found an ­early occlu­sion of ­bypass fol­lowed by ­major ampu­ta­tion in 5 ­cases (15.6%). ­Minor ampu­ta­tion had to be ­done in 12 ­patients (37.5%). Cumu­la­tive ­patency was 56.3% ­after 48 ­months. Fol­lowing the ­removal of super­fi­cial ­femoral ­vein, we had no com­pli­ca­tions due to ­venous ­stasis. We ­found a sig­nif­i­cant ­increase of ple­thys­mo­graph­i­cally meas­ured ­venous ­capacity (1.7±0.49 to 2.51±0.71 [p<0.01]) and ­venous out­flow (14.9±5.34 to 23.9±10.4 [p<0.05]) ­after 7.7 ­months. We did not ­observe ­more sig­nif­i­cant ­changes of ­venous cir­cu­la­tion ­during fur­ther ­follow-up.
Con­clu­sions. ­Despite ­overall ­good ­results, we ­only rec­om­mend the use of super­fi­cial ­femoral ­vein in haz­ardous sit­u­a­tions, ­when ­other autol­o­gous mate­rial is not avail­able.