Femorodistal vein bypass is regarded as gold standard for the treatment of limb threatening ischemia. Initially the procedure has been reported using saphenous vein (Rev Chir 70:206–35, 1951), mainly due to the lack of adequate vascular substitutes. Later vascular grafts have become available, and the enthusiasm to use autologous vein has faded, especially in difficult situations with no saphenous vein, although it is known that vein grafts perform superior to alloplastic vascular grafts.
A variety of methods gathered from literature have been collected and proven for their usefulness in everyday practice by the authors. We have a long-standing experience with femorodistal vein bypass using exclusively autologous vein allowing to critically evaluate current opinions on this topic.
The availability and technique of vein harvest of alternative vein for distal bypass is discussed, as well as the sequence of vein use, which is discussed in literature. Measures to increase vein availability, vein quality assessment, and methods for prevention of vein exhaustion are described.
More of 90 % of femorodistal bypass procedures can be accomplished with a vein graft even today. This requires a combination of dedication to bypass surgery, careful search for adequate vein, meticulous vein harvest, and attentive care to use vein resourced sensibly.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Kunlin J. Le traitement de l’ischemie arteritique par la greffe veneuse longue. Rev Chir. 1951;70:206–35.
Albers M, Romiti M, Brochado-Neto FC, Pereira CA. Meta-analysis of alternate autologous vein bypass grafts to infrapopliteal arteries. J Vasc Surg. 2005;42:449–55.
Lösel-Sadée H, Alefelder C. Heparin-bonded expanded polytetrafluoroethylene graft for infragenicular bypass: five-year results. J Cardiovasc Surg. 2009;50:339–43.
Kreienberg PB, Darling, RC, Chang BB, Champagne BJ, Paty PS, Roddy SP, Lloyd WE, Ozsvath KJ, Shah DM. Early results of a prospective randomized trial of spliced vein versus polytetrafluoroethylene graft with a distal vein cuff for limb-threatening ischemia. J Vasc Surg. 2002;35:299–306.
Faries PL, LoGerfo FW, Arora S, Hook S, Pulling MC, Akbari CM, Campbell DR, Pomposelli FB. A comparative study of alternative conduits for lower extremity revascularization: all-autogenous conduit versus prosthetic grafts. J Vasc Surg. 2000;32:1080–90.
Taylor L, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg. 1990;11:193–206.
Kent KC, Whittemore AD, Mannick JA. Short-term and midterm results of an all-autogenous tissue policy for infrainguinal reconstruction. J Vasc Surg. 1989;9:107–14.
Chew DK, Owend CD, Belkin M, Donaldson MC, Whittemore AD, Mannick JA, Conte MS. Bypass in the absence of ipsilateral greater saphenous vein: safety and superiority of the contralateral greater saphenous vein. J Vasc Surg. 2002;35:1085–92.
Chang BB, Paty PS, Shah DM, Leather RP. The lesser saphenous vein: an underappreciated source of autogenous vein. J Vasc Surg. 1992;15:152–57.
Schulman ML, Badhey MS, Yatco R, Pillary G. A saphenous alternative: preferential use of superficial femoral and popliteal veins as femoropopliteal bypass grafts. Am J Surg. 1986;152:231–7.
Schulman ML, Badhey MS, Yatco R, Pillary G. An 11-year experience with deep leg veins as femoropopliteal bypass grafts. Arch Surg. 1986;121:1010–5.
Hölzenbein TJ, Pomposelli FB, Miller A, Contreras MA, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW. Results of a policy with arm veins used as the first alternative to an unavailable ipsilateral greater saphenous vein for infrainguinal bypass. J Vasc Surg. 1996;23:130–40.
Hölzenbein TJ, Pomposelli FB, Miller A, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW. The upper arm basilic-cephalic loop for distal bypass grafting: technical considerations and follow-up. J Vasc Surg. 1995;21:586–92.
Jacob S, Kallikourdis A, El-Shafei H, Dunning J. What is the patency of the short saphenous vein when used for coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2007;6:783–6.
Licht P, Jacobsen E, Lerbjerg G, Andersen PE, Alstrup P. Cephalic vein in coronary artery bypass surgery. Eur J Cardiothorac Surg. 1996;10:327–30.
Stansby G. Vein quality in vascular surgery. Lancet. 1998;351:1001–2.
Luckraz H, Lowe J, Pugh N, Azzu AA. Pre-operative long saphenous vein mapping predicts vein anatomy and quality leading to improved post-operative leg morbidity. Interact Cardiovasc Thorac Surg. 2008;7:188–91.
Linni K, Mader N, Aspalter M, Butturini E, Ugurluoglu A, Hitzl W, Hölzenbein TJ. Ultrasonic vein mapping prior to infrainguinal autogenous bypass grafting reduces postoperative major surgical site infections and readmissions. J Vasc Surg. 2012;56:126–32.
Marcaccio EJ, Miller A, Tannenbaum GA, Lavin PT, Gibbons GW, Pomposelli FB, Freeman DV, Campbell DR, LoGerfo FW. Angioscopically directed interventions improve arm vein bypass grafts. J Vasc Surg. 1993;17:994–1004.
Miller A, Marcaccio EJ, Tannenbaum GA, Kwolek CJ, Stonebridge PA, Lavin PT, Gibbons GW, Pomposelli FB, Freeman DV, Campbell DR, LoGerfo FB. Comparison of angioscopy and angiograpy for monitoring infrainguinal bypass vein grafts: result of a prospective randomized trial. J Vasc Surg. 1993;17:382–96.
Hölzenbein TJ, Miller A, Tannenbaum GA, Contreras MA, Lavin PT, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW. Role of angioscopy for the failing or failed infrainguinal vein bypass graft. Ann Vasc Surg. 1994;8:74–91.
Mills JL, Taylor SM, Fujitani RM. The role of the deep femoral artery as an inflow site for infrainguinal revascularization. J Vasc Surg. 1993;18:416–23.
Natale A, Belcasto M, Pallesci A, Baldi I. The mid-distal deep femoral artery: few important centimeters in vascular surgery. Ann Vasc Surg. 2007;21:111–6.
Reed AB, Conte MS, Belkin M, Mannick JA, Whittemore AD, Donaldson MC. Usefulness of autogenous bypass grafts originating distal to the groin. J Vasc Surg. 2002;35:48–55.
Schanzer A, Owens CD, Conte MS, Belkin M. Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts. J Vasc Surg. 2007;45:740–3.
Böhmig HJ, Zeidler G, Schwierz T, Loy E. 20 Jahre orthograder Venenbypass für infrainguinale arterielle Rekonstruktionen. Chirurg. 1995;66:120–6.
Crawford RS, Chung TK, Hodgman T, Pedraza JD, Corej M, Cambria RP. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg. 2007;46:41–8.
Kretschmer G, Hölzenbein TJ. Oral anticoagulation in peripheral vascular surgery: how intense, for how long, or at all? J Intern Med. 1999;245:389–97.
Becquemin JP. Effect of ticlopidine on the long-term patency of saphenous-vein bypass grafts in the legs Etude de la Ticlopidine aprés Pontage Fémoro-Poplité and the Association Universitaire de Recherche en Chirurgie. N Engl J Med. 1997;337:1726–31.
Algra A, Tangelder MJ, Lawson JA, Eikelboom BC. Interpretation of the Dutch BOA trial: Dutch bypass oral anticoagulants or aspirin study group. Lancet. 2000;355:1186–7.
Londrey GL, Bosher LP, Stoneburner FD, Pancoast JW, Davis RK. Infrainguinal reconstruction with arm vein, lesser saphenous vein and remnants of greater saphenous vein: a report of 257 cases. J Vasc Surg. 1994;20:451–7.
Davies AH, Hawdon AJ, Sydes MR, Thompson SG, et al. Is duplex surveillance of value after leg vein bypass grafting? Principal results of the vein graft surveillance randomized trial (VGST). Circulation. 2005;112:1985–91.
Sesto ME, Sullivan TM, Hertzer NR, Krajewski LP, OʼHara PJ, Beven EG. Cephalic vein grafts for lower extremity revascularization. J Vasc Surg. 1992;15:543–9.
Deutsch M, Meinhart J, Howanietz N, Fröschl A, Heine B, Sisel A, Stümpflen A, Zilla P. The bridge graft: a new concept for infraopopliteal surgery. Eur J Vasc Endovas Surg. 2001;21:508–12.
Conflict of interest
The authors declare that there are no actual or potential conflicts of interest in relation to this article.
About this article
Cite this article
Hölzenbein, T., Aspalter, M., Metzger, P. et al. The all autologous vein policy in infrainguinal bypass surgery. Eur Surg 46, 260–266 (2014). https://doi.org/10.1007/s10353-014-0290-8
- Distal bypass surgery
- Greater saphenous vein
- Arm veins
- Lesser saphenous vein
- Autologous vein policy