Technical factors affecting autogenous vein graft failure: observations from a large multicenter trial

Area of Science:

• Vascular Surgery
• Surgical Outcomes Research
• Biomaterials Science

Background:

• Operator-dependent variables in lower extremity bypass (LEB) surgery outcomes are typically from single-institution retrospective studies.
• A prospective, multicenter trial offers a robust platform to identify technical factors influencing autogenous LEB for limb salvage.

Purpose of the Study:

• To identify technical variables significantly associated with early and midterm results of autogenous LEB for limb salvage.
• To analyze the impact of specific technical factors on graft patency and patient outcomes.

Main Methods:

• Utilized data from the PREVENT III trial, including 1404 North American patients with critical limb ischemia (CLI) undergoing LEB with autogenous vein.
• Analyzed technical factors: vein diameter, conduit type, graft length, anastomosis location, and completion imaging.
• Employed univariate and multivariate Cox regression analyses to assess effects on 30-day and 1-year outcomes (primary patency, primary assisted patency, secondary patency), adjusting for patient comorbidities.

Main Results:

• Vein diameter less than 3.5 mm and composite graft types were linked to early graft failure.
• At 1 year, smaller diameter (<3.5 mm), non-great saphenous vein (GSV) types, and longer grafts (>50 cm) were associated with reduced patency rates.
• High-risk conduits (diameter <3 mm or non-single segment GSV) increased 30-day graft failure risk by 2.1-fold and led to more reinterventions and longer hospital stays.

Conclusions:

• Vein diameter and conduit type are primary technical determinants of early and late graft failure in LEB for CLI.
• High-risk conduits and longer grafts warrant aggressive postoperative surveillance to improve outcomes.