Lower extremity arterial revascularization using conditioned small-diameter great saphenous vein.

OBJECTIVE: This study was conducted to determine whether it was feasible to increase the diameter of smaller great saphenous veins (GSVs) in preparation for possible bypass and whether such a conditioned conduit could be used with reasonable patency.

METHODS: Twenty-five patients (26 cases: 24 peripheral arterial occlusive disease, 2 popliteal aneurysms) with GSV diameters between 2 and 3 mm underwent in situ GSV valvulotomy and were observed for 3 months. After GSV dilation to >3 mm for below-knee revascularization and >3.5 mm for above-knee revascularization, arterial bypass surgery was performed with the valvulotomized GSV.

RESULTS: Adequate GSV diameter was reached in 20 cases (77%). Arterial bypass surgery using valvulotomized GSV was performed an average 131 days (range, 64-373 days) after valvulotomy in 16 patients (61.5%). No deaths, amputations, or aneurysms occurred 2 years after surgery. At 1 and 2 years, primary patency was 81% ± 9.8% and 69% ± 11.8%, respectively, and secondary patency was 87% ± 8.3% and 75% ± 11%, respectively.

CONCLUSIONS: Valvulotomy can be used to expand small-diameter GSV for lower extremity arterial bypass.