In situ vein bypasses to distal tibial and limited outflow tracts for limb salvage.

To better define the limits of tibial reconstruction with saphenous vein bypass, we have analyzed our experience with the in situ vein valve incision technique in 83 cases of bypasses to the ankle or foot and 13 cases of bypasses to discontinuous tibial vessels. Bypasses to the ankle and foot had a 36-month cumulative patency rate of 70.4%. No statistical difference was noted with the use of small-caliber veins. The length of the bypass did not prejudice the long-term patency rate. Discontinuous tibial vessels can be used satisfactorily as an outflow tract for limb salvage.