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The use of arm veins for infrainguinal bypass in end-stage peripheral vascular disease
J D Balshi1, N L Cantelmo, J O Menzoian
1Department of Surgery, Boston University School of Medicine, MA.
Insights
Autologous arm vein bypass grafts show high success rates for treating critical limb ischemia. These grafts offer excellent patency and limb salvage, making them a preferred option when saphenous veins are unavailable.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Peripheral Artery Disease
Background:
- Infrainguinal bypass grafting is crucial for limb salvage in patients with critical limb ischemia.
- Autologous saphenous vein is the preferred conduit, but its availability is often limited.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using autologous arm vein for infrainguinal bypass grafting.
- To determine the patency rates and limb salvage achieved with arm vein grafts.
Main Methods:
- Retrospective analysis of 36 infrainguinal bypass grafts in 33 patients using autologous arm vein.
- Indications included ischemic rest pain or tissue loss.
- Follow-up ranged from three weeks to six years.
Main Results:
- One-year primary and secondary patency rates were 73% and 82%, respectively.
- Simple arm vein grafts achieved 75% primary and 85% secondary patency.
- Limb salvage rate was 86% with no early occlusions or late failures beyond nine months.
Conclusions:
- Autologous arm vein bypass grafts demonstrate excellent patency and limb salvage rates.
- Arm vein grafts are a viable and preferred alternative conduit when autologous saphenous vein is unavailable.
- This approach effectively addresses critical limb ischemia in a challenging patient population.
Abstract:
Thirty-six infrainguinal bypass grafts were performed in 33 patients with the use of autologous arm vein. Indications for operation were ischemic rest pain or tissue loss in all patients. The average age of the patients was 70.0 years-27% were diabetic and 66% were smokers. Sixty-five percent of the grafts were performed as secondary reconstructions. Follow-up ranged from three weeks to six years, with a mean of 12.1 months. Life-table primary and secondary patencies for all grafts are 73% and 82% at one year, respectively. Simple (noncomposite) arm vein grafts had primary and secondary patencies of 75% and 85%, respectively. The limb salvage rate was 86%. No grafts required thrombectomy for early occlusion (less than 30 days), and no graft failures have occurred beyond nine months (n = 18). Arm vein bypass grafts demonstrate excellent patency rates and provide the preferred conduit in the absence of autologous saphenous vein.