The In Situ Bypass Above the Knee

The anatomical location of the saphenous vein in the distal thigh allows for construction of an in situ bypass to the above-knee popliteal artery. The authors have performed over 1400 in situ bypasses in the past 10 years. Forty-three of these have been to the above-knee popliteal artery. Thirty-three bypasses were performed for limb threatening ischemia, seven for disabling claudication and three for microemboli. Mean patient age was 67 years, 51% were males, 44% had diabetes mellitus, and 93% smoked. Grafts were followed from one to 108 months. The cumulative patency rate at two years was 90% and at four years 77%. Patency rates compare favorably to those of femoral-to-above-knee popliteal bypasses constructed using reversed saphenous vein or polytetrafluoroethylene. The authors found that the in situ femoral-to-above-knee popliteal bypass is a technically easy procedure requiring short operative times and has a low morbidity rate. In those select patients in whom a femoral-to-above-knee bypass is the procedure of choice the in situ bypass should be considered.