Comparison of reversed, nonreversed translocated, and in situ vein grafts in arterial revascularization: Techniques, cumulative patency, versatility, and durability

Abstract

Since Carrell and Guthrie used the reversed saphenous vein graft for arterial reconstruction in 1906 [1], this technique has undergone several technical modifications to earn its popularity and credibility [2–4]. Vein preparation has also been refined to attain optimal preservation of histocytologic integrity in order to improve graft patency [6–12]. Notwithstanding the periodical enthusiasm to substitute saphenous vein with biologic [13–15] or prosthetic grafts [16–18], or prosthetic graft with a venous cuff [19–21] for expedience, autogenous vein graft remains the preferred conduit and the gold standard in vascular bypass operations. Autogenous vein graft has been subjected to intense scrutiny for optimal morphologic preservation and identification of etiologic factors contributing to segmental fibrosclerosis and aneurysmic degeneration. The anatomic orientation of reversed versus nonreversed vein graft has also been extensively evaluated for their role in long-term graft function and patency [22]. Despite the initial nongermane attitude toward vein preparation, there is evidence to support the importance of the pH, osmolality, osmolarity, and the duration of storage in media, in the preservation of the integrity of cellular and extracellular elements of the vein grafts [5,9,10,23–25]. It is well established that durability and long-term patency of a vein graft is frequently the by-product of at least four vital elements: vein quality, vein preparation, anatomic orientation and surgical technique.