Late results and angiographic evaluation of arm veins as long bypass grafts.

Late results and angiographic evaluation of arm veins as arterial bypass grafts have not been reported previously. From 1969 to 1979, 68 long bypasses were performed using arm veins exclusively. There were 41 femoropopliteal bypasses, 6 peripheral aneurysm resections, 16 femorotibial bypasses, and 5 other bypasses. Sixty-four patients have been followed from 2 to 10 years. In peripheral aneurysm cases, all grafts were patent at 1 year, and long-term patency (to 127 months) was achieved in five of six patients. In the 41 femoropopliteal bypasses, cumulative life table patency rates at 1, 2, 3, and 5 years were 62%, 47%, 31%, and 31%. Unlike grafts with saphenous veins, significant graft attrition occurred in the second and third postoperative years. With femorotibial bypasses, the 1-, 2-, and 5-year life table patency rates were 43%, 31%, 15%. Late (4- to 10-year) angiographic evaluation of seven grafts revealed a pattern of graft elongation and dilation. One aneurysmal graft, partially resected 103 months after insertion, showed atheromatous changes. These results suggest that when used as infrainguinal bypass grafts, arm veins have distinct limitations and may be inferior to other presently available material. Critical review of the literature supports this conclusion.