Distal bypass with a varicose vein graft for critical limb ischemia: report of a case

Short-Term Results of Varicose Vein Graft Used for Lower-Limb Bypass Surgery

Objective: Due to the potential of thrombus blockage and aneurysm rupture, saphenous veins with varicose veins are not advised for use as bypass grafts. However, if no other autologous vein is accessible for use as a conduit in lower-limb bypass; varicose vein transplants may be employed. Few reports have studied the clinical results of lower-limb bypass using varicose vein grafts. We therefore investigated whether or not acceptable patency rates of varicose vein graft for lower-limb bypass could be achieved. Methods: We performed lower-limb bypass using varicose vein graft on nine limbs from June 2017 to May 2020 and conducted a retrospective analysis of prospectively collected data. Results: Early graft failure following bypass surgery using a varicose vein transplant was not detected, and major complications, such as acute graft occlusion or aneurysm dilatation, were not noted throughout the follow-up period. The primary and secondary patency of varicose vein graft was 70.0% and 100% at 3 years, respectively. Conclusion: The incidence of major problems of the varicose vein transplants does not seem to be higher than with conventional saphenous vein grafts. If there are no other appropriate autologous veins, a varicose vein graft may be useful as a conduit for bypass surgery.

Ethics and rationale for sparing the saphenous vein

Not available.

Femoropopliteal Bypasses with Varicose Great Saphenous Vein

The great saphenous vein is the conduit of choice for femoropopliteal or infrapopliteal bypass, but it is traditionally recommended that varicose vein grafts (VVGs) should not be used for bypass conduits owing to the risk of immediate rupture or long-term aneurysmal change. Herein, we report two cases of femoropopliteal bypass with VVGs. They achieved primary patency without aneurysmal formation after 32 and 17 months. Therefore, VVGs without morphologically conspicuous abnormalities are worth considering for usage as a vein graft.

Long-Term Result of Tibioperoneal Trunk Bypass with an Autogenous Graft Using the Varicose Great Saphenous Vein for Acute Limb Ischemia

For the management of acute limb ischemia (ALI) and multilevel arterial occlusive disease, tibial bypass using the saphenous vein has been considered a mainstay due to the long-term durability in selected patients with acceptable saphenous veins and comorbid conditions. Traditionally, bypass using a varicose autogenous graft has been contraindicated due to the risk of late aneurysmal dilation and rupture. Here, we describe a patient who presented with ALI and received tibioperoneal trunk bypass using a varicose autogenous graft. The patient has been doing well during the 72-month follow-up without recurrent symptoms or revision. The follow-up images showed a favorably patent graft with mild aneurysmal changes at the valve cusp adjacent to the knee. If there are no other appropriate autologous veins for revascularization, a varicose autogenous vein graft may be a useful option for limb salvaging in selected patients with multilevel arterial occlusive diseases.