Autologous alternative vein grafts for infrainguinal bypass in the absence of single segment great saphenous vein - single center study.

OBJECTIVES: Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice.

METHODS: This is a single center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023.

RESULTS: During study period 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischaemia 41 (83.7%); acute limb ischaemia 3 (6.1%); complications of previous prosthetic 3 (6.1%) or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femoro-tibial, 11 (22.4%) femoro-popliteal, 9 (18.4%) femoro-pedal, and 5 (10.2%) extension jump bypass procedures. 18 (36.7%) operations were re-do surgeries. 21 (42.9%) bypasses were formed using only arm veins. Median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year, primary patency rates were 93.7% ± 3.5%; 84.8% ± 5.9%; 80.6% ± 6.9%, and secondary patency rates (SP) were 95.8% ± 2.9%; 89.2% ± 5.3%; 89.2% ± 5.3%. 1-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). 2-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%.

CONCLUSIONS: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.