Lesser saphenous vein (LSV) in distal revascularisation for limb salvage [La vena piccola safena (VPS) nelle rivascolarizzazioni distali per salvataggio degli arti inferiori]

Background. The study aimed to evaluate the possibility of revascularising the extremities using the LSV in the absence of the greater saphenous vein (GSV). Methods. A total of 482 distal revascularisations were performed between 1984 and 1998 for critical leg ischemia in 454 patients. LSV was used in 77 cases in which GSV was not available. GSV was not present for the following reasons: previous aortocoronary bypass in 22 cases; earlier revascularisation of extremities failed in 36 cases; stripping in 5 cases; varicophlebitis in 3 cases; partial or total inadequacy of GSV in 11 cases. The indications for therapy in this group of patients were: resting pain in 3 cases, trophic disorders in 20 cases, gangrene of the toes in 48 cases and gangrene of the heel in 6 cases. The following techniques were used: exclusive bypass with LSV in 34 cases; compound bypass with PTFE in 5 cases; sequential bypass below other vein grafts or prostheses in 18 cases; secondary repair or extension of bypass using LSV in 20 cases. Contralateral LSV was not used in any case. Results. The results included operating mortality in 1 case, acute arterial occlusion in 10 cases (13%), amputation in 3 cases (3.9%), local complications in 4 cases (5.2%) in the form of cutaneous necrosis (Achilles tendon and calf). Late results: 5 bypasses became occluded during the postoperative period and 27 patients died from other causes (ischemic cardiomyopathy, stroke, etc.). Conclusions. LSV is an adequate arterial substitute which can be used if GSV is not available, achieving a slightly lower patency rate and a higher cutaneous morbidity and enabling the venous resources of the contralateral limb to be preserved.