The type of graft used depends on the diameter of the vessel required and on the availability of an autograft.
The long saphenous vein is usually used, providing its diameter on duplex scanning is 3.5 mm or above (Fig. 15.10). Arm veins are less robust and tend to dilate with time but are a good option if no leg veins are available. They should be marked pre-operatively, under duplex control if necessary. The vein may be prepared by removing and reversing it before reinsertion. It may also be used in the 'in situ' mode, whereby it is not removed but simply anastomosed at both ends after destroying the valves with a valvulotome. All the side branches have to be ligated.
This has a lower long-term patency and much higher infection rate than autogenous vein.
These grafts have a well-established place in large arterial reconstruction and they have yet to be surpassed for long-term patency and strength. They may be impregnated with rifampicin to render them more resistant to infection or heparin to lower their thrombogenicity.
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