Outcomes of Infrapopliteal Bypass With Alternative Grafts in the Absence of Single-Segment Great Saphenous Vein

The aim of this study was to analyze the outcomes of patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal (IP) bypass, using alternative conduits.

A single-center retrospective analysis of IP bypass was performed between 2012 and 2023. Patients were divided in three groups based on conduits: single-segment great saphenous vein (ssGSV), heparin-bonded expanded polytetrafluoroethylene (HePTFE), and alternative autologous venous grafts (AAVGs). The primary endpoint was 1-year freedom from CLTI. Secondary endpoints were recurrence of CLTI, limb salvage, survival, amputation-free survival (AFS), and primary patency (PP) and tertiary patency (TP) rates at 3 years of follow-up.

A total of 480 IP bypasses were performed in 424 patients with CLTI, 31% (150/480) with HePTFE and 8% (38/480) with AAVG. Median age was 72 years (interquartile range [IQR]: 15) and 76% (366/480) were male. Median follow-up was 23 months (IQR: 42). Overall, 93% (446/480) had tissue loss, and 45% (200/446) of those had some degree of infection. One-year freedom from CLTI was achieved in 77% of the overall population, with no difference between the three groups (adjusted hazard ratio (aHR): 0.91, confidence interval [CI]: 0.78-1.06, P = 0.219). HePTFE had higher 3-year recurrence of CLTI when compared with ssGSV (45% vs. 18%, aHR: 3.80, CI: 1.85-7.82, P < 0.001). No differences were observed between ssGSV and AAVG regarding 3-year recurrence of CLTI, limb salvage, survival, AFS, PP, and TP.

In the absence of an adequate ssGSV conduit, both AAVG and HePTFE grafts proved to be suitable alternatives for IP bypass. When feasible, AAVG should be preferred over HePTFE grafts.