Superficial femoral vein in arterial reconstruction for limb salvage: outcome and fate of venous circulation.

BACKGROUND: In some particular cases in vascular surgery it is mandatory to perform arterial reconstruction using autologous graft. Since 1985, we have been using the superficial femoral vein for arterial substitute in the case of limb salvage, when another autologous vein has not been available. We made a prospective investigation on 32 patients over a mean period of 24.5+/-12.1 months (1 to 48 months) to evaluate the usefulness of superficial femoral vein (SFV) for distal arterial reconstructive surgery and to objectify the fate of venous circulation of the limb after removal of this vein.

METHODS: There were 20 male and 12 female patients averaging 64.3+/-10.3 years, who underwent crural arterial reconstructive surgery using the composite technique (PTFE and SFV). All grafts had been placed subcutaneously in lateral to knee position. Mean length of removed superficial femoral vein was 13.2+/-9.4 cm.

RESULTS: In 6 patients (18.7%), we found an early occlusion of bypass followed by major amputation in 5 cases (15.6%). Minor amputation had to be done in 12 patients (37.5%). Cumulative patency was 56.3% after 48 months. Following the removal of superficial femoral vein, we had no complications due to venous stasis. We found a significant increase of plethysmographically measured venous capacity (1.7+/-0.49 to 2.51+/-0.71 [p<0.01]) and venous outflow (14.9+/-5.34 to 23.9+/-10.4 [p<0.05]) after 7.7 months. We did not observe more significant changes of venous circulation during further follow-up.

CONCLUSIONS: Despite overall good results, we only recommend the use of superficial femoral vein in hazardous situations, when other autologous material is not available.