Publication details
Autologous Alternative Vein Grafts for Infrainguinal Bypass in the Absence of Single-Segment Great Saphenous Vein: A Single-Center Study
| Authors | |
|---|---|
| Year of publication | 2024 |
| Type | Article in Periodical |
| Magazine / Source | Annals of Vascular Surgery |
| MU Faculty or unit | |
| Citation | |
| web | https://www.sciencedirect.com/science/article/abs/pii/S0890509624000529?via%3Dihub |
| Doi | http://dx.doi.org/10.1016/j.avsg.2023.12.067 |
| Keywords | Vein Grafts; Infrainguinal Bypass |
| Description | Background: Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice. Methods: This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023. Results: During the study period, 49 bypasses were done in 48 patients; mean age 68.1 +/- 9.8; men 32 (66.7%); body mass index 28.0 +/- 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5e24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% +/- 3.5%, 84.8% +/- 5.9%, and 80.6% +/- 6.9%, and secondary patency (SP) rates were 95.8% +/- 2.9%, 89.2% +/- 5.3%, and 89.2% +/- 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% +/- 0% vs 87.6% +/- 6.0%). Two-year amputation-free survival was 86.8% +/- 6.5%; 2-year overall survival was 88.2% +/- 6.6%. Conclusions: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single -segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice. |