Use of a nondissection method in lower extremity revascularization: A report on our 12-year experience of autogenous vein bypass surgery

We report herein on our 12-year experience of performing autogenous vein grafting in the lower extremity using a nondissection method. This method involves limiting preparation for the distal anastomosis to exposure of the anterior surface of the vascular sheath, and substituting an Esmarch's rubber bandage or a pneumatic tourniquet for vascular clamps. A series of 86 consecutive patients who received 101 autogenous vein grafts employing this method were retrospectively analyzed. The causes of arterial occlusion were atherosclerosis in 55 patients, Buerger's disease in 23, and other causes in 9. There was one operative death, and 12 late deaths were recorded within a follow-up period extending to 12 years. Of four early occlusions and two stenoses, three were successfully revised within 30 days of surgery. A total of 11 revision operations were required for 10 grafts during the follow-up period, and late graft closure occurred in 9 bypasses. The primary, primary revised, and secondary patency rates at 5 years for the entire series (n = 101) were 65%, 85%, and 86%, respectively, with 42 bypasses to the tibial or peroneal artery having 84% primary revised and 86% secondary patency rates. These findings led us to conclude that minimization of the surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.