SURGICAL-TREATMENT OF LOWER-EXTREMITY VASCULAR-DISEASE

Arterial bypass with autogenous vein has achieved excellent results in the treatment of lower extremity arterial occlusive disease. Greater saphenous vein has proven to be the conduit of choice for lower extremity bypass for limb salvage surgery, with lesser saphenous vein and cephalic vein serving as alternative sources of autogenous vein. The recent literature has emphasized graft surveillance with duplex scanning to detect significant flow-altering lesions associated with the bypass graft so these lesions can be repaired prior to graft thrombosis. The best method of graft revision has not been clearly established, but it has been substantiated that graft repair will lead to extended graft patency in an otherwise doomed bypass. In addition, recent evidence has described the potential role of saphenous vein disease in the early and late vein bypass failure.