Duplicate Great Saphenous Vein Utilization for Long Segment Tibial Bypass Without Need for Spliced Re-Anastomosis

Abstract

Introduction

There is significant benefit to utilizing autologous venous conduit in lower extremity arterial bypass surgery. Specifically, improved patency is well documented relative to prosthetic or non-autologous biological conduits. The smaller caliber the target artery, the more critical using an autologous conduit becomes in striving to achieve long term graft survival. Another benefit to venous conduit is resistance to infection.

Methods

Presented herein are the technique and images of a duplicate great saphenous vein (GSV) system with a common trunk being utilized to create a single long autologous venous conduit. Intraoperative images as well as conceptual drawing are provided. The non-reversed segment of the bypass is treated with a valvulatome. This allows for creation of a non-spliced autologous conduit when the distal aspect of the primary GSV is too diminutive for bypass.

Results

Surveillance duplex imaging 3 months after surgery revealed no evidence of stenosis in the bypass and a normalization of the ABI. The area corresponding to the repair of the common trunk was identified on duplex and noted to have a robust diameter. He is doing well with full resolution of rest pain and claudication symptoms.

Conclusion

This technique of utilizing a duplicate greater saphenous vein system to maintain a single lower extremity autologous venous conduit for arterial bypass is beneficial to keep in the armamentarium of vascular surgeons.