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Contemporary Use of the Femoropopliteal Vein in Vascular Reconstructions 19

Discussion popliteal vein and associated with : harvested, remaining deep veins after FPV
7
Graft infection following aortic reconstruction harvest, and the collateral vessels between the

can cause mortality (10-25%) and limb loss 1. Significant reflux disease in the veins popliteal vein and profunda femoris vein can
(10-25%). A similar incidence is also reported remaining after FPV harvest prevent post-harvest morbidity. 7

with mycotic aneurysms. The traditional
methods of graft excision with extra-anatomic or 2. Absence of collateral veins from the References:

in situ bypass carry a graft-failure rate of almost popliteal vein to profunda femoris vein or 1) Aru RG, Horsley NB, Endean ED. Contemporary use of
35% and re-infection rates between 10-23%. common femoral vein the femoropopliteal vein in vascular reconstructions. Ann
4
Vasc Surg. 2022;79:145-152.
Greater saphenous vein shows poor patency and doi:10.1016/j.avsg.2021.07.019
up to 60% failure rates when used for in-situ Based on these findings, an anatomic “safe” 2) Hirsch JA, Leslie-Mazwi TM, Nicola GN, et al. Current

reconstruction. 5 length of FPV to be harvested was determined procedural terminology; a primer. J Neurointerv Surg.
2015;7(4):309-312. doi:10.1136/neurintsurg-2014-011156
which included one valve in the distal profunda

FPV has several advantages for autogenous femoris stump (to prevent reflux) and one 3) CPT Advisor. Adjunctive use of the superficial femoral
vein for vascular reconstructions. Sean P. Roddy.
reconstruction post arterial and prosthetic graft significant collateral vein (more than 2 mm in https://www.jvascsurg.org/arti-
cle/S0741-5214(12)00483-1/pd-
infections with primary patency of 83-91%, diameter) in the popliteal vein stump superior to f#:~:text=The%20add%2Don%20CPT%20code,edition%20
secondary patency of up to 100% at 5 years the valve. In the given study, this length of FPV of%20the%20CPT%20manual. Accessed June 2022

(range: 7.4 months to 10 years), and limb salvage harvested varied from an average of 40 cm in 4) Ehsan O, Gibbons CP. A 10-year experience of using
femoro-popliteal vein for re-vascularisation in graft and
rates of more than 85%. The five-year survival for women to 50 cm in men when 15 cm of the arterial infections. Eur J Vasc Endovasc Surg.

the FPV by-pass was also better than the popliteal vein in men and 13 cm in women was 2009;38(2):172-179. doi:10.1016/j.ejvs.2009.03.009
prosthetic replacement (60-70% vs 47-56%). harvested distal to the inferior edge of the 5) Daenens K, Fourneau I, Nevelsteen A. Ten-year experi-
4
ence in autogenous reconstruction with the femoral vein
More than one study has shown no adductor hiatus. 7 in the treatment of aortofemoral prosthetic infection. Eur
J Vasc Endovasc Surg. 2003;25(3):240-245.
late-treatment-related mortality due to the doi:10.1053/ejvs.2002.1835

complete absence of graft re-infection. Any Conclusion:
4,5
6) Hagino RT, Bengtson TD, Fosdick DA, Valentine RJ,
unresolved infection was successfully shown to FPV is a useful, almost universally available, and Clagett GP. Venous reconstructions using the superficial
femoral-popliteal vein. J Vasc Surg. 1997;26(5):829-837.
be treated with further FPV grafts and rates of durable option for a potential conduit. 1 doi:10.1016/s0741-5214(97)70097-1
re-infection if reported were low. 4
7) Santilli SM, Lee ES, Wernsing SE, Diedrich DA, Kuskows-
FPV has been shown to be an excellent conduit ki MA, Shew RL. Superficial femoral popliteal vein: An
anatomic study. J Vasc Surg. 2000;31(3):450-455.
FPV is also an ideal conduit for major venous for arterial reconstruction in the presence of

reconstructions due to its durability, availability, prosthetic graft infection and provides better
size, and length. But there is inconsistency long-term survival. 4
6
regarding the incidence of post-FPV-harvest
morbidities like pain and swelling. This variation Although the morbidity related to vein harvest

is attributed to a lack of standards for length of and system complications are high with FPV
vein harvested, preoperative venous evaluations, conduits, it can be explored further for use in

and postoperative care. The venous morbidity vascular reconstruction. 1
7
associated with FPV harvest has now been

shown to be more likely caused by the harvest of Studies suggest that the length of vein