A simple means of access for harvesting the lesser saphenous vein

Abstract

Enhanced patient expectations combined with improvements in vascular technique have increased the number of lower limb arterial bypass operations performed. The natural consequence is a parallel increase in the number of re-operations for failed or failing bypasses where the optimal conduit--the ipsilateral long saphenous vein has already been used. Indeed, there are many occasions where the long saphenous vein cannot be utilised at the primary operation, either because of the demands of coronary artery bypass surgery, or because of the presence of phlebitic vein segments. As autologous vein is generally preferred to prosthetic material for distal (tibial) bypasses, the vein must be harvested from other sites. Frequently there is insufficient or inadequate arm vein from a single source. Also, there is a natural reluctance to use the contralateral long saphenous vein, even if it is still available, because of the potential need for an arterial bypass on that side. The short saphenous vein is a valuable alternative. We describe a simplified approach (compared to the more conventional posterior approach) to harvest this vein which can then be used either in isolation or in combination with a superficial femoral endarterectomy or as part of a composite vein graft.