Short vein grafts: A superior option for arterial reconstructions to poor or compromised outflow tracts?

To determine whether vein graft length is a factor that influences infrapopliteal bypass patency, we reviewed 237 consecutive reversed saphenous vein bypasses performed because of critical ischemia during a 5-year period. One hundred seventeen long vein grafts (LVGs) were longer than 40 cm (42 to 92 cm, mean 60.9 ± 9 cm) and 120 short vein grafts (SVGs) were 40 cm or shorter (6 to 40 cm, mean 24.7 ± 8 cm). Ninety-three percent of the LVGs originated from or were proximal to the superficial femoral artery (SFA) whereas all of the SVGs originated at or distal to the SFA. The cumulative patency rate for LVGs at 3 years was 45% and for SVGs was 63% (p < 0.025). In the absence of an intact pedal arch, 3-year patency rates for LVGs (51 cases) and SVGs (78 cases) were 22% and 53%, respectively (p < 0.01). High intraoperative outflow resistance measurements (>0.7 mm Hg/ml/min) were encountered in 25 cases. Of these, occlusion within 6 months occurred in six of seven cases with LVGs and in only 8 of 18 cases with SVGs (p < 0.05). Wound complications at vein harvest sites occurred in 17% of LVGs and in only 6% of SVGs (p < 0.01). Of 16 additional cases in which a proximal patch angioplasty or percutaneous transluminal angioplasty was performed tandem with a short distal vein graft, four occluded (less than 6 months) and 12 remained patent from 3 to 43 months (mean 12.6 months). Thus SVGs, in addition to increasing vein utilization and decreasing wound complications, have superior patency rates, particularly when used in bypasses to disadvantaged outflow tracts. Early results with tandem procedures are encouraging.