Related Experiment Videos
The use of arm vein conduits during infrageniculate arterial bypass
T R Harward1, D Coe, T C Flynn
1Section of Vascular Surgery, University of Florida College of Medicine, Gainesville 32610-0286.
Insights
Arm veins serve as a viable alternative for arterial bypass surgery, demonstrating good initial patency and limb salvage rates. Even composite grafts using arm veins achieve favorable long-term results for infrapopliteal bypass.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Biomaterials in Medicine
Background:
- The popliteal and infrapopliteal arteries are critical for lower limb perfusion.
- Autologous venous conduits are preferred for arterial bypass, with the saphenous vein being the most common.
- Alternative venous sources are needed when saphenous vein is unavailable or insufficient.
Purpose of the Study:
- To evaluate the efficacy and safety of using arm veins as conduits for infrageniculate arterial bypass.
- To assess graft patency and limb salvage rates in patients undergoing bypass with arm vein grafts.
- To compare outcomes of single-segment versus composite arm vein grafts.
Main Methods:
- Retrospective review of 43 patients undergoing infrageniculate arterial bypass using arm vein conduits.
- Grafts included bypasses to the popliteal artery (n=9) and infrapopliteal arteries (n=34).
- Grafts were either single-segment arm vein (n=6) or composite (arm vein alone or with saphenous vein, n=37).
Main Results:
- Initial (30-day) graft patency and limb salvage were high at 95%.
- Primary 3-year graft patency was 49%, increasing to 64% secondary patency after salvage interventions.
- Secondary patency for infrapopliteal bypasses reached 66% at 3 years, with limb salvage at 63%.
Conclusions:
- Arm veins are an effective alternative venous conduit for infrageniculate arterial bypass.
- Composite venous grafts incorporating arm vein segments yield acceptable long-term results.
- Successful salvage of failing grafts, particularly with anticoagulation, improves overall limb salvage rates.
Abstract:
To further examine the use of arm vein for bypass to the popliteal or infrapopliteal arteries, we retrospectively reviewed 43 patients undergoing infrageniculate arterial bypass by use of an arm vein as a conduit. Nine grafts were done to the below-knee popliteal artery and 34 to the infrapopliteal arteries. Six grafts were done by use of a single segment of an arm vein, whereas 37 grafts were composites of either multiple segments of arm vein (n = 19) or segments of saphenous and arm vein (n = 18). Mean follow-up time was 15 1/2 months. Initial (30-day) graft patency and limb salvage were 95%. Primary graft patency by life-table analysis was 67% at 1 year and 49% at 3 years. Follow-up examination detected graft stenosis before occlusion in six patients (all of whom were given anticoagulant medication) and three failing grafts were salvaged. This increased overall 3-year secondary graft patency to 64% and 3-year secondary patency for infrapopliteal bypasses to 66%. Eleven of 12 graft occlusions resulted in major amputations (eight were above the knee, and three were below the knee) so that limb salvage paralleled secondary graft patency (63% at 3 years). Thus arm veins provide an excellent alternative venous conduit for infrageniculate arterial bypass, even when composite venous grafts must be used.