Distal Anastomotic Hyperplasia in Superficial Femoral-Popliteal Vein Femoropopliteal Bypass Grafts

The incidence of distal anastomotic hyperplasia (DAH) in superficial femoral- popliteal veins (SF-PVs) used as femoropopliteal bypass (FPB) grafts was inves tigated, with particular reference to the form of distal anastomotic construction. Seventy-seven SF-PV grafts that met specific angiographic follow-up criteria quali fied as "studied" grafts. DAH was identified in 13 (17%). Cobra head anastomoses, 2 cm or less in length, were used in 21 grafts and yielded 6 in stances of DAH (29%). When 8 sharply tapered 3 cm (swordfish) anastomoses were constructed, 3 grafts (37.5%) developed DAH. With 3 cm moderately ta pered (fishmouth) anastomoses in 48 grafts, DAH was seen 4 times (8%). Be cause the distal 1 cm of the swordfish configuration was very narrow, the swordfish and cobra head constructions were functionally equivalent and were grouped together as "short" anastomoses. The difference in the incidence of DAH with long and short anastomoses, 8% vs 31%, was statistically significant (p = .016).In the 48 "st...