Failure of autogenous reversed saphenous vein femoropopliteal grafting: pathophysiology and prevention.

As part of a study of various clinical, pathologic, and hemodynamic factors on both short- and long-term patency of autogenous reversed saphenous vein femoropopliteal bypass grafts, an early and recent series of patients from Yale University School of Medicine is compared with four other index series. Review and comparison reveals a well-recognized pattern of graft failure that occurs in three definable periods. The closure rate differs between periods and among series and allows a delineation of the responsible factors. Improvement in long-term cumulative patency rate depends on an understanding of the factors responsible for vein graft failure and the methods for their elimination or control.