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Infrainguinal arterial bypasses using dilated varicose veins selectively wrapped with prosthetic segments - late results

Didier Mellière Maria Claudia de Albuquerque Pascal Desgranges Eric Allaire Jean Pierre Becquemin About the authors

OBJECTIVE: To answer the following questions: 1) is it necessary to excise and suture the dilatations before wrapping? 2) are the wrapped segments at risk of hyperplasia or stenosis? 3) are the non-wrapped areas at risk of dilatation and rupture? METHODS: Infrainguinal revascularization was performed in 12 patients (10 males, two females), aged 33-77 years (mean age = 68). Surgical indication was arteritis (n = 7), popliteal aneurysm (n = 4), or rupture of a Dacron graft (n = 1). Location of the bypass was femoro-popliteal (n = 8), femoro-infrapopliteal (n = 3) or popliteo-popliteal (n = 1). Position of the vein was ex situ, either reversed (n = 9) or non-reversed devalvulated (n = 3). The number of dilatations reinforced with a graft were one (n = 2), two (n = 3), three (n = 6) and four (n = 1). All reinforcements except one were made with PTFE grafts. RESULTS: Two vein bypasses occluded, one early due to distal bed deficit and the other one 4 years after the surgery. The other 10 grafts remained patent during the follow-up, which ranged from 1 to 11 years (mean = 4 years). Half of the patients demonstrated some degree of progressive deterioration of the distal bed. At the last control, two patients had a patent bypass in spite of a deserted run-off. CONCLUSION: The results of this series show that long-term patency of the wrapped vein-bypasses look far better than those of prosthetic-grafts in this location described in the literature. The wrapping can be easily performed with a short thin wall PTFE graft. It is useless to reduce the dilatations before the wrapping by suture or resection - anastomosis. Wrapped segments will not develop hyperplastic stenosis. Unwrapped segments may enlarge moderately without a risk of rupture.

arterial bypass; grafts; varicose veins

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