Print this pageRevision of Venous Bypass Conduits: Venous Patch Versus Interposition
Paul B. Kreienberg, MD, R Clement Darling III, Benjamin B. Chang, MD, Philip S.K. Paty, MD, Sean P. Roddy, MD, Kathleen J. Ozsvath, MD, Manish Mehta, MD, Yaron Sternbach, MD and Dhiraj M. Shah, MD
Albany Medical College, Albany, NY
Purpose: The importance of graft surveillance after infra-inguinal reconstruction has been well documented. However, when intrinsic bypass lesions are identified by surveillance protocol the optimal technique of revision is debatable. This study reviews our experience with vein patch or interposition vein to treat in bypass stenoses. This analysis does not include proximal or distal jump revisions.
Methods: Between 1985 and 2004, 6698 vein bypasses were performed at our institution. All bypasses were followed with duplex ultrasound at 3, 6, 12, 18 and 24 months and then yearly after that. Occlusive lesions identified by surveillance were then revised with either venous patches or interposition veins determined by extent of lesion, vein availability and surgeon’s judgment.
Results: A total of 6698 bypasses were performed during the study interval. 4237 were in situ vein, 1727 excised vein and 734 spliced vein bypasses. 34 bypasses were revised with a venous patch and 56 were repaired with interposition vein. Patency of all bypasses revised with interposition vein was 81% at 2 years and 76% at 4 years. An in situ bypass revised with interposition vein was 86% at 2 years and 81% at 4 years. Vein patch for revision yielded 2 year patency of 76% and 4 years of 76%. Excised vein bypasses revised with patches had patency of 89% at 2 years. Excised veins revised with interposition vein had a patency of 76% at 2 years and 70% at 4 years (p=NS).
Conclusion: Similar results are obtained whether revision is done with interposition vein or a vein patch. Therefore, vein availability, size match and anatomic factors (length of occlusive lesion) should determine what technique to use for bypass revision.