29 Long Term Results of In Situ Saphenous Vein Bypass Analysis of 2058 Cases скачать в хорошем качестве

29 Long Term Results of In Situ Saphenous Vein Bypass Analysis of 2058 Cases

#InSituBypass #VascularSurgery #CriticalLimbIschemia #LimbSalvage #Patency #Shaw1995 #LandmarkPaper #SaphenousVeinBypass #PeripheralArteryDisease #Atherosclerosis This summary discusses a landmark paper by Shaw et al. from 1995, detailed in the book "50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know". The study focuses on the long-term results of the in situ saphenous vein bypass technique for treating severe leg ischemia, also known as limb-threatening ischemia. Historically, surgeons often used the reversed saphenous vein, removing it and flipping it to bypass vein valves, but this caused size mismatch issues. The in situ technique leaves the vein in its natural place, providing a better size match with arteries. The key technical challenge was managing the internal valves, overcome by developing techniques for valve incision or valvulotomy. Shaw et al.'s study analysed 2058 in situ saphenous vein bypasses performed between 1975 and 1995, primarily in patients with limb-threatening ischemia (91%). A major strength was the long-term follow-up, with 95% of patients tracked for up to 10 years, using rigorous monitoring. The findings were highly impressive, demonstrating the durability of the technique. Primary patency (graft staying open without intervention) was 84% at one year, 72% at five years, and remarkably 55% at ten years. Assisted primary patency (including minor procedures) was even higher: 91% at one year, 81% at five, and 70% at ten years. Limb salvage rates were exceptional: 99% at 30 days, 97% at one year, 95% at five years, and 90% even after ten years. Crucially, the study found no statistically significant difference in patency based on factors like bypass length, vein diameter, gender, or whether the patient had diabetes. This finding was particularly reassuring to surgeons, suggesting the technique was robust across various patient and procedural characteristics. This paper was hugely influential, providing strong evidence for the reliable, durable, long-term success of the in situ technique, especially compared to historical reversed vein results. It bolstered surgeon confidence in attempting technically demanding distal bypasses further down the leg. Despite limitations as a single-center, mostly retrospective study on de novo cases, Shaw et al. solidified in situ bypass as a cornerstone technique for limb salvage.