Unusual Autogenous Vein Grafts

Since 1973 the authors have used 32 unusual autogenous veins for infrainguinal reconstruction. Grafts used were 2 nondominant profunda femoris, 10 profunda femoris-popliteal, 1 nondominant superficial femoral, 2 contralateral superficial femoral, 1 common femoral, 1 posterior tibial, 5 axillary, 4 tibioperoneal trunk, and 6 saphenous "spare tires." The popliteal vein normally drains into the superficial femoral vein, forming a superficial femoral-popliteal vein that merges with the smaller, nondominant profunda femoris vein; in 7% of limbs, however, the popliteal vein flows directly into the profunda femoris vein, resulting in a dominant profunda femoris-popliteal vein and a nondominant superficial femoral vein that originates in the thigh. Saphenous "spare tires" are saphenous veins harvested after prior deep vein resection; their unique characteristics are responsible for their inclusion in this report. Three grafts presented unacceptable intraoperative or early postoperative problems; all others proved to be satisfactory conduits. Meaningful evaluation of function in this diverse group of grafts was difficult, but in the 17 grafts placed since 1982, which represent a modern experience, primary and secondary patency rates were 87% and 94%, respectively, at three years. Of equal significance is the clinical utility of these grafts: their use has enabled the authors to use autogenous lower extremity veins exclusively in 114 of 115 consecutive infrainguinal reconstructions. No clinically significant late sequelae resulted from resecting these major veins, suggesting that the reserve and the regenerative capacity of the normal venous system is greater than generally appreciated. These grafts expand the pool of autogenous alternatives and may further reduce the need for prosthetic use.