Wrapped autologous greater saphenous vein bypass for severe limb ischemia in patients with varicose veins. Preliminary report.

The greater saphenous veins in patients with varicose veins has been overlooked as a conduit for arterial bypass. Greater saphenous veins is often normal and when only parts of the greater saphenous veins are of normal size, a veno-venous or a graft composite bypass may be performed. The goal of this preliminary study was to asses if wrapped autologous greater saphenous veins could be suitable conduits for arterial bypass in patients presenting with critical ischemia. In three patients the greater saphenous veins had one to four dilatations which were wrapped with short segments of Polytetrafluoroethylene graft. In three other patients, the dilated area being longer, the greater saphenous veins were totally wrapped in a hand-made mesh of Dacron. No complications were due to the wrapping procedure and the unwrapped segments did not dilate during a mean three year follow-up. We conclude that wrapped autologous greater saphenous veins may help save limbs of patients with critical ischemia. As an underestimated proportion of patients presenting with varicose tributaries have normal or quite normal greater saphenous veins, the caliber of the greater saphenous veins should be carefully measured before treating the varicose veins. All greater saphenous veins suitable for an arterial bypass should be preserved remembering that one or several dilatations may be wrapped if the greater saphenous veins is used as an arterial substitute. Patients should be informed of the reasons for this choice.