RT Book, Section A1 Ellison, E. Christopher A1 Zollinger, Robert M. SR Print(0) ID 1127274998 T1 SAPHENOUS VEIN IN SITU ARTERIAL BYPASS T2 Zollinger's Atlas of Surgical Operations, 10e YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179755-9 LK accesssurgery.mhmedical.com/content.aspx?aid=1127274998 RD 2024/03/28 AB Infrainguinal arterial bypass procedures may be indicated in patients with critical limb ischemia, including rest pain, tissue loss such as gangrene of the toes or ulceration of the foot or ankle, or with progressive, severe claudication. Compared to bypass procedures using either a synthetic graft or a reversed autogenous saphenous vein, the use of the in situ saphenous vein technique is preferred by some surgeons. Currently, there are no significant differences in patency rates between the in situ and reversed vein grafts. Hence, the choice is largely a matter of surgeon preference. In addition, this technique may be preferred when the distal anastomosis is to the tibial and peroneal arteries. This is because the vein size tapers in the anatomic direction, in contrast to reversed vein grafts. The taper results in a more well-matched anastomosis as the sizes are more comparable, and potentially in improved hemodynamic flow. It is believed that all these factors contribute to the improved results over prosthetic material for a biologically living bypass graft whose natural lining is not thrombogenic.