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Arm vein reconstruction for limb salvage: long-term outcome
P V Tisi1, A J Crow, C P Shearman
1Department of Vascular Surgery, Royal South Hampshire Hospital, Southampton.
Annals of the Royal College of Surgeons of England
|November 1, 1996
Summary
Arm vein grafts offer a viable solution for limb salvage in infrainguinal vascular reconstruction when long saphenous veins are unavailable. These grafts demonstrate comparable stenosis rates to traditional options and can be successfully treated with angioplasty.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Vascular Grafts
Background:
- Infrainguinal vascular reconstruction is crucial for limb salvage.
- The long saphenous vein is the preferred autologous conduit, but its availability is often limited.
- Alternative conduits are necessary for complex or repeat reconstructions.
Purpose of the Study:
- To prospectively evaluate the long-term patency and stenosis rates of arm vein grafts in infrainguinal vascular reconstruction.
- To assess the limb salvage rates associated with using arm vein grafts.
- To determine the efficacy of percutaneous transluminal angioplasty (PTA) for managing arm vein graft stenosis.
Main Methods:
- Prospective follow-up of 42 consecutive patients undergoing infrainguinal vascular reconstruction using arm vein grafts.
- Data collection on graft patency (primary, primary assisted, secondary), limb salvage, and graft surveillance.
- Analysis of stenosis development and treatment outcomes, including PTA and surgical revision.
Main Results:
- Two-year cumulative primary, primary assisted, and secondary graft patency rates were 35.6%, 49.6%, and 59.5%, respectively.
- The limb salvage rate at two years was 69.0%.
- Eight grafts developed stenosis, with successful PTA in six cases and an interposition vein graft in one case.
Conclusions:
- Arm vein grafts are a valuable option for infrainguinal vascular reconstruction, particularly when the long saphenous vein is absent.
- Stenosis rates for arm vein grafts are comparable to long saphenous vein grafts and are effectively managed with PTA.
- Despite technical challenges, arm vein grafts provide a durable solution for limb salvage.