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Influence of vein size (diameter) on infrapopliteal reversed vein graft patency
K R Wengerter1, F J Veith, S K Gupta
1Division of Vascular Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, New York, N.Y.
Insights
Graft diameter significantly impacts bypass success. Smaller reversed saphenous vein grafts (<3.0 mm) and long 3.0 mm grafts show high failure rates, while larger grafts (≥4.0 mm) offer better patency and limb salvage.
Area of Science:
- Vascular Surgery
- Graft Patency Studies
- Peripheral Artery Disease Treatment
Background:
- Infrapopliteal bypass surgery is crucial for critical limb ischemia.
- Reversed greater saphenous vein (rGSV) is a common autograft.
- Vein diameter is a potential determinant of graft success.
Purpose of the Study:
- To evaluate the impact of external vein diameter on infrapopliteal rGSV bypass graft patency and limb salvage.
- To identify optimal vein diameter thresholds for successful bypass surgery.
Main Methods:
- Retrospective review of 239 infrapopliteal rGSV bypasses over 7 years.
- Grafts categorized by minimum external diameter: <3.0 mm, 3.0 mm, 3.5 mm, ≥4.0 mm.
- Analysis of graft patency and limb salvage rates across diameter groups.
Main Results:
- Increasing minimum external vein diameter correlated with improved graft patency and limb salvage.
- Grafts <3.0 mm had 0% patency at 3 years vs. 65% for ≥4.0 mm grafts (p<0.001).
- Long (≥45 cm) 3.0 mm grafts showed lower patency (38% at 2 years) than ≥4.0 mm grafts (75%, p<0.005).
- Fibrotic veins had significantly lower patency rates (p<0.01).
Conclusions:
- Minimum external vein diameter is a critical predictor of infrapopliteal rGSV bypass outcomes.
- Grafts <3.0 mm and long 3.0 mm rGSVs are at high risk of failure.
- Vein diameter ≥3.5 mm, and short 3.0 mm veins, demonstrate comparable patency to larger grafts.
Abstract:
We reviewed 239 infrapopliteal reversed greater saphenous vein graft bypasses placed for critical ischemia over a 7-year period to determine the influence of vein diameter on graft patency and limb salvage. Grafts were assigned to four groups based on the minimum external diameter measured during operation: less than 3.0 mm, n = 18; 3.0 mm, n = 59; 3.5 mm, n = 67; and greater than or equal to 4.0 mm, n = 145. A pattern of increasing graft patency and limb salvage among the four groups was noted as the minimum external diameter increased from less than 3.0 mm to greater than or equal to 4.0 mm. When compared to the larger grafts greater than or equal to 4.0 mm, primary graft patency was significantly lower both for less than 3.0 mm grafts (0% for less than 3.0 mm vs 65% for greater than or equal to 4.0 mm at 3 years, p less than 0.001) and for long (greater than 45 cm) 3.0 mm grafts (38% for long 3.0 mm vs 75% for greater than or equal to 4.0 mm at 2 years, p less than 0.005). All 3.5 mm and short (less than 45 cm) 3.0 mm grafts had patency rates similar to greater than or equal to 4.0 mm veins. Thus long 3.0 mm and all less than 3.0 mm reversed saphenous vein grafts should be considered at high risk for failure. Veins with fibrotic, thick-walled segments identified during operation (n = 19) had patency rates significantly lower than nonfibrotic veins (n = 270; p less than 0.01), and this may play a role in the failure of some less than 3.0 mm minimum external diameter vein grafts.