BACKGROUND: One-piece great saphenous vein (GSV) is the conduit of choice in infrainguinal revascularizations for critical limb ischemia (CLI). Unfortunately, adequate length of usable GSV is not always available. Despite inferior patency rates compared with GSV, prosthetic and arm vein conduits are generally considered usable. The purpose of this study was to compare the outcome of infrainguinal arm vein and prosthetic bypass. MATERIAL AND METHODS: We retrospectively reviewed 290 consecutive infrainguinal bypasses for CLI using arm vein conduit (n = 130) or prosthetic graft (n = 160) during January 2000 and December 2006 at our institution. The groups were compared for risk factors, indication for surgery, and runoff score. Survival, leg salvage, and patency rates were calculated with the Kaplan-Meier method. RESULTS: Median surveillance time was 35 months (range 0-118 months). The age, gender, and usual risk factors were similar in arm vein and prosthetic groups, except cerebrovascular disease that was more common in the prosthetic group (P = .011). Indication for surgery was CLI. In the arm vein group, more than two-thirds (70.2%) of the procedures were for ischemic ulcer or gangrene, whereas in the prosthetic group the main indication was ischemic rest pain (51.3%). When the outcome of femoropopliteal bypasses was analyzed, the difference between groups was not statistically significant. However, in infrapopliteal revascularizations primary patency, assisted primary patency, and secondary patency rates at 3 years were significantly better in the arm vein group: 28.3% (SE +/- 6.3%) vs 9.6% (SE +/- 8.1%) (P = .031), 56.8% (SE +/- 6.6%) vs 10.4% (SE +/- 8.7%) (P = .000), and 57.4% (SE +/- 6.6) vs 11.2% (SE +/- 9.3%) (P = .000), respectively. Leg salvage and survival at 3 years were 75.0% (SE +/- 4.9%) vs 57.1% (SE +/- 8.8%) (P = .005) and 58.8% (SE +/- 5.1%) vs 39.5% (SE +/- 7.7%) (P = .007), respectively. CONCLUSION: Arm vein conduits, even when spliced, are superior to prosthetic grafts in terms of midterm assisted primary patency, secondary patency, and leg salvage in infrapopliteal bypasses for CLI.
BACKGROUND: One-piece great saphenous vein (GSV) is the conduit of choice in infrainguinal revascularizations for critical limb ischemia (CLI). Unfortunately, adequate length of usable GSV is not always available. Despite inferior patency rates compared with GSV, prosthetic and arm vein conduits are generally considered usable. The purpose of this study was to compare the outcome of infrainguinal arm vein and prosthetic bypass. MATERIAL AND METHODS: We retrospectively reviewed 290 consecutive infrainguinal bypasses for CLI using arm vein conduit (n = 130) or prosthetic graft (n = 160) during January 2000 and December 2006 at our institution. The groups were compared for risk factors, indication for surgery, and runoff score. Survival, leg salvage, and patency rates were calculated with the Kaplan-Meier method. RESULTS: Median surveillance time was 35 months (range 0-118 months). The age, gender, and usual risk factors were similar in arm vein and prosthetic groups, except cerebrovascular disease that was more common in the prosthetic group (P = .011). Indication for surgery was CLI. In the arm vein group, more than two-thirds (70.2%) of the procedures were for ischemiculcer or gangrene, whereas in the prosthetic group the main indication was ischemic rest pain (51.3%). When the outcome of femoropopliteal bypasses was analyzed, the difference between groups was not statistically significant. However, in infrapopliteal revascularizations primary patency, assisted primary patency, and secondary patency rates at 3 years were significantly better in the arm vein group: 28.3% (SE +/- 6.3%) vs 9.6% (SE +/- 8.1%) (P = .031), 56.8% (SE +/- 6.6%) vs 10.4% (SE +/- 8.7%) (P = .000), and 57.4% (SE +/- 6.6) vs 11.2% (SE +/- 9.3%) (P = .000), respectively. Leg salvage and survival at 3 years were 75.0% (SE +/- 4.9%) vs 57.1% (SE +/- 8.8%) (P = .005) and 58.8% (SE +/- 5.1%) vs 39.5% (SE +/- 7.7%) (P = .007), respectively. CONCLUSION: Arm vein conduits, even when spliced, are superior to prosthetic grafts in terms of midterm assisted primary patency, secondary patency, and leg salvage in infrapopliteal bypasses for CLI.
Authors: Bjoern D Suckow; Larry W Kraiss; David H Stone; Andres Schanzer; Daniel J Bertges; Donald T Baril; Jack L Cronenwett; Philip P Goodney Journal: Ann Vasc Surg Date: 2013-09-05 Impact factor: 1.466
Authors: Catherine K Chang; Salvatore T Scali; Robert J Feezor; Adam W Beck; Alyson L Waterman; Thomas S Huber; Scott A Berceli Journal: J Vasc Surg Date: 2014-07-16 Impact factor: 4.268
Authors: Maria Teresa B Abola; Jonathan Golledge; Tetsuro Miyata; Seung-Woon Rha; Bryan P Yan; Timothy C Dy; Marie Simonette V Ganzon; Pankaj Kumar Handa; Salim Harris; Jiang Zhisheng; Ramakrishna Pinjala; Peter Ashley Robless; Hiroyoshi Yokoi; Elaine B Alajar; April Ann Bermudez-Delos Santos; Elmer Jasper B Llanes; Gay Marjorie Obrado-Nabablit; Noemi S Pestaño; Felix Eduardo Punzalan; Bernadette Tumanan-Mendoza Journal: J Atheroscler Thromb Date: 2020-07-04 Impact factor: 4.928
Authors: James T McPhee; Philip P Goodney; Andres Schanzer; Shimon Shaykevich; Michael Belkin; Matthew T Menard Journal: J Vasc Surg Date: 2013-02-01 Impact factor: 4.268
Authors: Mario González-Gay; Rocío López-Martínez; Sara Busto-Suárez; Mariel Estefanía Riedemann-Wistuba; María Ángeles Menéndez-Herrero; Francisco Álvarez-Marcos; Manuel Alonso-Pérez; Rebeca Alonso-Arias Journal: Front Surg Date: 2020-12-22