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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
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Saphenous Vein Arterialization for Limb Salvage in Unreconstructable Peripheral Arterial Disease: Long-Term Results

Hailey Shoemaker1, David L Lau2, Brent A Safran2

  • 1Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA.

Annals of Vascular Surgery
|March 27, 2026
PubMed

Insights

Great saphenous vein arterialization (GSVA) is a promising limb salvage technique for chronic limb-threatening ischemia (CLTI). This study shows GSVA achieves over 50% below-knee amputation-free survival at one year with significant wound healing.

Area of Science:

  • Vascular Surgery
  • Peripheral Arterial Disease Management
  • Limb Salvage Procedures

Background:

  • Chronic limb-threatening ischemia (CLTI) represents the advanced stage of peripheral arterial disease.
  • Many CLTI patients lack suitable distal targets for revascularization, leading to high amputation rates.
  • Great saphenous vein arterialization (GSVA) with pedal valve disruption is an emerging technique for limb salvage.

Purpose of the Study:

  • To evaluate the 12-month outcomes of amputation, pain, and wound healing in patients with unreconstructable CLTI treated with GSVA.
  • To assess the efficacy of GSVA as a limb-salvage strategy in a challenging patient population.

Main Methods:

  • A cohort of 15 patients (20 limbs) with unreconstructable CLTI underwent GSVA between October 2019 and August 2024.
  • The procedure involved using the great saphenous vein in situ, anastomosed to the most distal patent artery, with central and peripheral valve disruption.
  • Outcomes were retrospectively assessed via chart review up to August 2025.

Main Results:

  • GSVA was technically successful in all cases with no major operative complications.
  • Among 19 limbs with 12-month follow-up, below-knee amputation (BKA)-free survival was 53%; overall BKA-free survival was 55%.
  • In limbs not requiring BKA, 91% showed wound healing and pain improvement, with most amputations occurring early post-procedure.

Conclusions:

  • GSVA with pedal valve disruption is a viable limb-salvage option for patients with unreconstructable CLTI.
  • The technique achieves over 50% BKA-free survival at one year and promotes significant wound healing.
  • Further research is necessary to optimize patient selection and improve outcomes for GSVA in CLTI management.
Abstract

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