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It is well known that patients who require vascular grafting of arteries below the inguinal, or groin, region have a better outcome when the saphenous vein of the leg is used as the graft conduit, rather than synthetic graft material. When the saphenous vein can not be used, good results have been obtained using other veins, such as the short saphenous vein, an arm vein or even a deep leg vein. The advantages of using the patient's own vein as a conduit are even greater when a vein, rather than an artery, is being replaced. If a vein is to replace another vein, the caliber (size of the lumen, or internal diameter) of the vessels must match. Large veins, such as the vena cava, may be replaced by using deep leg veins, such as the superficial femoral-popliteal vein in the thigh-knee area. This procedure has not gained widespread acceptance because of fear of restricting the venous outflow from the donor leg. A study was undertaken to evaluate the effects of excision of a deep leg vein in two groups of patients: 21 patients (25 legs) underwent femoropopliteal arterial bypass using the femoral-popliteal vein; 19 patients (22 legs) had the same bypass operation performed, except that synthetic graft was used and the femoral-popliteal vein was left intact (control group). Patients were evaluated after surgery both clinically and functionally. The legs that had been vein donors showed a small, but significant increase in average calf diameter compared with the control group. This was the only sign or symptom of chronic venous stasis. Venous outflow obstruction was shown on X-ray study of the veins in 21 of 25 vein donor legs (84 percent), compared with only 50 percent of the control legs. However, symptomatically the vein donor patients were not statistically different from the control group; three months after surgery 40 percent of the donor group and 40.9 percent of the control group complained of swelling. These results suggest that the deep veins of the leg may be considered for use as arterial grafts if superficial veins are not available. (Consumer Summary produced by Reliance Medical Information, Inc.)

There are few reports of vascular (blood vessels) reconstructive surgery performed to relieve arterial insufficiency in patients who have end-stage (terminal) kidney disease. These patients are believed to be poor risks for vascular surgery; many are diabetic and often have diffuse, severe arterial disease with calcification of the arteries. A study was undertaken of 39 patients with end-stage renal disease who underwent limb revascularization surgery to determine if the standard criteria for revascularization could be applied to this group of patients. Fifty-six legs underwent infrainguinal revascularization (bypass graft) surgery; nine legs had additional surgery for the removal of blood clots. Thirty-seven of the 39 patients were on dialysis, and 3 patients had functioning transplanted kidneys. Vascular surgery was performed because of ischemia (inadequate blood supply) resulting in gangrene (tissue death), leg pain at rest, leg ulcers, or severe claudication (leg cramping when walking). The rate of patency of the grafts at one year was 77 percent, and 68 percent at two years. During the follow-up period, which averaged 23 months (range 0 to 115 months), there were 24 deaths. Five deaths occurred in the perioperative period (shortly before to shortly after surgery), three of which were due to heart attack. At three years, 39 percent of the patients were alive with 84 percent of legs saved. These findings suggest that limb revascularization can be successfully performed on patients with end-stage renal disease, and that the standard criteria for revascularization surgery can be applied. (Consumer Summary produced by Reliance Medical Information, Inc.)

BACKGROUND: Lymphatic leakage is a relatively uncommon but serious complication following vascular procedures. A conservative approach consisting of bed rest, leg elevation, prophylactic antibiotics, compressive dressings, and intermittent aspiration is the most commonly used treatment. Because of the long time it takes to cure this condition and the potential for infections, a more aggressive approach consisting of wound exploration and ligation of the leaking lymphatic has been proposed. We review our experience of the past 3 years treating 17 of these complications by using 1 of these 2 approaches. PATIENTS AND METHODS: Seventeen groin complications were seen over a period of 3 years. Ten (59%) patients were treated by selective ligation assisted with isosulfan blue dye injection, and the remaining 7 (41%) were treated conservatively. RESULTS: Mean hospital stay was 2.4 days (range 1 to 4) for the operative group versus 19 days (range 14 to 42) for the conservative group. One complication was seen in the operative group, whereas 4 (57%) patients developed groin infections following conservative therapy. One (10%) patient developed a recurrence following ligation that was treated successfully by reoperation. CONCLUSION: Our experience with the use of surgical ligation of leaking lymphatic assisted by isosulfan blue, when compared with conservative treatment, has led to a decrease in hospital stay, lower complication rates, and fewer recurrences. in our view, this approach represents the best form of treatment for postoperative groin lymphatic complications. Am J Surg. 1995;170: 206-208.