Dawn M Coleman1, John E Rectenwald2, Frank C Vandy2, Thomas W Wakefield2. 1. Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich. Electronic address: dawnbarn@umich.edu. 2. Section of Vascular Surgery, Department of Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Mich.
Abstract
BACKGROUND: Chronic occlusion of the femoral or the proximal popliteal vein responsible for venous obstruction and the constellation of clinical sequelae that ensue remains a surgical challenge that carries notable patient morbidity. Sapheno-popliteal bypass (SPB) remains a surgical reconstructive option for select patients that demonstrate patency of the popliteal vein, great saphenous vein, saphenofemoral junction, and iliac veins. We sought to analyze our single-institution experience with this technique. METHODS: A retrospective review of a single-center experience with SPB was performed. Preoperative risk factors and indications for intervention (ie, venous claudication, ulceration) were identified. Duration of follow-up and endpoints, including clinical improvement, wound healing, patency, and limb loss were assessed. A Kaplan-Meier analysis for primary and secondary patency was performed. RESULTS: Seventeen patients underwent SPB for chronic lower extremity venous obstruction between July 1988 and August 2011. Median age at operation was 41 years (range, 23-69 years). There was a male predominance noted (n = 12; 71%). All patients had chronic edema and venous claudication. Five patients (29%) had evidence of venous ulceration preoperatively. Eight patients (47%) underwent a preceding venous intervention (ie, iliac stenting or venous thrombolysis). Three patients had a concomitant arteriovenous fistula, created at the time of bypass to enhance in-flow; three patients underwent concomitant femoral-femoral venous bypass. Four patients (24%) experienced hematoma postoperatively that required operative evacuation; in two patients, compression from this hematoma resulted in early graft occlusion. After a median follow-up of 103 months (range, 3-271 months), 82% of patients experienced near or complete resolution of venous claudication. Three of the five patients with venous ulceration healed their wounds (67%). Of the 16 patients that underwent Duplex scan follow-up, primary patency after a median follow-up of 103 months was 56%, primary-assisted patency was 69%, and secondary patency was 75%. One patient required amputation approximately 21 years after SPB and there were no deaths. This secondary patency rate exceeds previously published patency rates. CONCLUSIONS: SPB may be indicated for certain patients with chronic venous stasis disease secondary to femoral venous obstruction that have failed other standard therapies. SPB remains a satisfactory and reliable procedure that produces clinical improvement in a selected group of patients and should be considered in a contemporary venous surgical practice.
BACKGROUND:Chronic occlusion of the femoral or the proximal popliteal vein responsible for venous obstruction and the constellation of clinical sequelae that ensue remains a surgical challenge that carries notable patient morbidity. Sapheno-popliteal bypass (SPB) remains a surgical reconstructive option for select patients that demonstrate patency of the popliteal vein, great saphenous vein, saphenofemoral junction, and iliac veins. We sought to analyze our single-institution experience with this technique. METHODS: A retrospective review of a single-center experience with SPB was performed. Preoperative risk factors and indications for intervention (ie, venous claudication, ulceration) were identified. Duration of follow-up and endpoints, including clinical improvement, wound healing, patency, and limb loss were assessed. A Kaplan-Meier analysis for primary and secondary patency was performed. RESULTS: Seventeen patients underwent SPB for chronic lower extremity venous obstruction between July 1988 and August 2011. Median age at operation was 41 years (range, 23-69 years). There was a male predominance noted (n = 12; 71%). All patients had chronic edema and venous claudication. Five patients (29%) had evidence of venous ulceration preoperatively. Eight patients (47%) underwent a preceding venous intervention (ie, iliac stenting or venous thrombolysis). Three patients had a concomitant arteriovenous fistula, created at the time of bypass to enhance in-flow; three patients underwent concomitant femoral-femoral venous bypass. Four patients (24%) experienced hematoma postoperatively that required operative evacuation; in two patients, compression from this hematoma resulted in early graft occlusion. After a median follow-up of 103 months (range, 3-271 months), 82% of patients experienced near or complete resolution of venous claudication. Three of the five patients with venous ulceration healed their wounds (67%). Of the 16 patients that underwent Duplex scan follow-up, primary patency after a median follow-up of 103 months was 56%, primary-assisted patency was 69%, and secondary patency was 75%. One patient required amputation approximately 21 years after SPB and there were no deaths. This secondary patency rate exceeds previously published patency rates. CONCLUSIONS:SPB may be indicated for certain patients with chronic venous stasis disease secondary to femoral venous obstruction that have failed other standard therapies. SPB remains a satisfactory and reliable procedure that produces clinical improvement in a selected group of patients and should be considered in a contemporary venous surgical practice.