Femoro-distal bypass with varicose veins covered by prosthetic mesh

Background. The great saphenous vein (GSV) is the material of choice in distal bypass for critical limb ischemia (CLI). Varicosities have been reported as the cause of inadequacy of vein in up to 20% of patients. The hypothesis of this study is to consider the external mesh as a technique to use like conduit, in patients with varicose veins and in young patients with ecstatic veins, with results that at least overlap the traditional technique. We report our experience with bypass surgery using autologous varicose vein covered with prosthetic mesh. Materials and Methods. From May 2005 to July 2008, 249 infrapopliteal bypasses were performed to treat CLI. Twenty-one patients were selected from this group to receive bypass covered by polyester external mesh (ProVena; BBraun, Aesculap, Tuttlingen, Germany). Seventeen patients had varicose veins, four young patients had venous ectasia or previous bypass failure for dilatation. Graft patency was evaluated at 1, 3, 6, and 12 mo, and every 6 mo thereafter. All patients underwent epidural anesthesia with ropivacain 0.75%. Results. The mean follow-up time was 32 mo. No dilatation or infection was found in this period. Two early bypass thromboses were recorded and treated immediately. Two lesions were treated at 3 and 8 mo with surgical substitution of the distal portion and PTA of focal intermediate stenosis, respectively. Primary patency at 24 mo was 57.1% (SE +/- 3.9), assisted 81% (SE +/- 3.2), and had an amputation-free survival rate of 85.7% (SE +/- 2.8). In other bypass without mesh, primary patency was 63.8%, secondary 80.5%, and amputation-free survival rate 89.3% at 24 mo. Conclusion. Polyester external mesh is a valid method to perform bypass with autologous material, as ectatic or varicose veins. Moreover, in young patients with long-term bypass patency expectancy, it prevents vein dilatation during arterialization process. (C) 2011 Elsevier Inc. All rights reserved.