Over a three-year period (1984–1987), we performed 98 in situ saphenous vein bypasses to the tibial arteries in 89 patients. In 68 of these grafts, the distal anastomoses were above ankle level. All but one of these grafts were performed for limb salvage indications. Seven (10%) of these grafts were done in patients on chronic renal dialysis. In 30 grafts, the distal anastomoses were to the ankle level. Indications for surgery were risk of limb loss in all of these patients, with tissue loss in 29 (97%). Six (20%) were done in patients on chronic renal dialysis. Operative mortality was 3% in both groups. Late mortality was 13% in the above-ankle group, and 27% in the ankle level group. Secondary patency for the above-ankle group was 97%, 85%, 81%, and 81% at 30 days, one year, two years, and three years. Primary patency was 91%, 67%, and 58% at 30 days, one year, and two years, after which the standard error is greater than 10%. Secondary patency for the grafts at the ankle level was 100% and 82% at 30 days and one and one-half years. Primary patency rates were 93% and 68% at 30 days and one year. In situ bypass grafts at the ankle level had patency rates equivalent to grafts with distal anastomoses above the ankle. Patients with distal bypasses usually presented with tissue loss and had a higher late mortality rate. Careful follow-up and operative intervention when changes in graft velocities or indices are recognized, markedly improves the durability of the in situ saphenous vein bypass.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
LEVINE AW, BANDYK DF, BONIER PH, TOWNE JB. Lessons learned in adopting the in situ saphenous vein bypass.J Vasc Surg 1985;2:145–153.
BANDYK DF, CATO RF, TOWNE JB. A low flow velocity predicts failure of femoropopliteal and femorotibial bypass grafts.Surgery 1985;98:799–809.
CUTLER SJ, EDERER F. Maximum utilization of the life table method in analyzing survival.J Chronic Dis 1958;8:699–712.
BANDYK DF, KAEBNICK HW, STEWART GW, TOWNE JB. Durability of the in situ saphenous vein arterial bypass: a comparison of primary and secondary patency.J Vasc Surg 1987;5:256–268.
BUCHBINDER D, PASCH AR, ROLLINS DL, DILLON BC, DOUGLAS DJ, SCHULER JJ, FLANIGAN DP. Results of arterial reconstruction of the foot.Arch Surg 1986;121:673–677.
About this article
Cite this article
Levine, A.W., Davis, R.C., Gingery, R.O. et al. In situ bypass to the dorsalis pedis and tibial arteries at the ankle. Annals of Vascular Surgery 3, 205–209 (1989). https://doi.org/10.1007/BF03187394
- dorsalis pedis
- saphenous vein bypass