Use of lower extremity deep veins as arterial substitutes: Functional status of the donor leg

Large veins (superior and inferior vena cava, portal vein) have been replaced successfully with lower extremity deep veins (superficial femoral-popliteal). Femoropopliteal bypass with superficial femoral-popliteal veins has been reported to give excellent long-term results. Nevertheless, this source of autogenous veins has not gained acceptance, in part because of the fear that deep vein removal will result in severe venous outflow restriction in the donor limb. To assess the clinical and functional effect of excising a deep vein, we compared a group of limbs in which the superficial femoral-popliteal vein was resected for use as a femoropopliteal bypass graft (25 legs) with a control group of 22 legs in which a saphenous vein or polytetrafluoroethylene graft was used for femoropopliteal bypass. No significant differences were found in age or sex distribution, time from surgery to the venous test, side of bypass, or the incidence of postoperative extremity swelling, either early or late. A mild but significant calf enlargement was observed in the deep vein group (p < 0.05), and a pattern consistent with venous outflow obstruction was shown by plethysmography in 21 of 25 extremities (84%) in which a deep vein was used for femoropopliteal bypass but in only 11 of 22 (50%) control extremities (p < 0.02). It is concluded that a lower extremity deep veins should be considered as a suitable replacement for a large vein or, when superficial vein is not available, as an infrainguinal arterial substitute.