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The use of arm veins as peripheral vascular grafts
1Department of Surgery, St. Joseph Hospital, Eindhoven, The Netherlands.
Insights
Arm vein grafts show promising patency rates for critical limb ischemia, even in complex cases. These bypasses offer a viable option when synthetic materials fail, demonstrating long-term success.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
Background:
- Below-knee femoropopliteal and femorodistal bypasses using nonautologous materials often have poor patency rates.
- Patients with critical limb ischemia frequently require complex revascularization procedures.
Abstract:
Below-knee femoro-popliteal and especially femoro-distal bypass with nonautologous bypass material is met with poor patency rates. During an eight-year period, nine (composite) arm-vein grafts were done in eight patients. In only one patient, the arm-vein bypass was a primary procedure. In four patients this concerned a secondary procedure and in four a tertiary procedure. All eight patients demonstrated critical ischaemia of the affected limb. Distal anastomosis involved the below-knee popliteal artery in three cases and the tibial artery in the remainder six. In all but one case runoff was poor to extremely poor. Notwithstanding these unfavourable characteristics, eight out of nine bypasses have remained patent after a mean follow-up of 29 months (range five to 72 months). The only bypass that occluded did so without any symptoms or effect on the viability of the foot. In four patients, the arm veins were too narrow for grafting. Four to six weeks after construction of an arteriovenous fistula at the wrist their arm veins were at least partially suitable for grafting.