The myth of the in situ graft: Superiority in infrainguinal bypass surgery?

Abstract

Objectives: to compare the clinical outcome of in situ and reversed bypass grafting. Design: multicentre, prospective, non-randomised study. Patients and methods: five-hundred patients with an in situ graft and 955 patients with a reversed graft were compared regarding graft occlusion, the need for graft revision, and limb salvage. Results: two-year assisted primary patency of femoropopliteal bypass procedures was 82% for in situ and 82% for reversed grafts. The corresponding hazard ration (HR) for occlusion was 1.27 (95% CI 0.91-1.77). The 2-year assisted primary patency of femorocrural bypass procedures was 69% for in situ vs. 70% for reversed grafts. The corresponding HR was 1.13 (95% CI 0.73-1.75). Adjustment for relevant baseline variables did not change the results. More reinterventions were needed to maintain integrity and patency of the in situ graft especially in crural bypasses. No differences in limb salvage rates were seen. Conclusions: reversed and in situ vein grafts have similar patency and limb salvage rates for both femoropopliteal and fomorocrural bypass procedures. The in situ graft needs more secondary interventions.