Technical factors in lower-extremity vein bypass surgery: how can we improve outcomes?

摘要: Lower-extremity vein bypass surgery has been a standard operation in the armamentarium of vascular surgeons for more than 4 decades. Yet there remains surprising heterogeneity utilization, techniques, and outcomes associated with this procedure current practice. Despite improvements surgical technique careful postoperative surveillance, graft failure significant clinical problem affecting up to 50% patients within 5 years. Experience, judgment, creativity, technical precision are required optimize long-term results. Many factors, including patient-specific comorbidities, variable biologic responses venous conduit, influence ultimate outcome. Technical however, play dominant role determining success. Multiple single-center reports, recent multicenter trials, have clearly demonstrated that conduit selection quality is most critical element. An adequate caliber (≥3.5 mm), good great saphenous optimal infrainguinal bypass. Contralateral vein, arm lesser next desirable conduits. Graft configuration (reversed, nonreversed, or situ) appears little on per se. Shorter grafts improved patency. Inflow can be by endovascular means if necessary, distal-origin perform as well those originating from common femoral artery. The selected outflow vessel should supply unimpeded runoff foot, conserve length, allow soft-tissue coverage simplified exposure. This review summarizes data linking factors patency, highlighting importance judgment operative planning practice surgery.