Arm Vein as an Alternative Autogenous Conduit for Infragenicular Bypass in the Treatment of Critical Limb Ischaemia: A 15 Year Experience. EJVES June 2014
what do we know?
The results for bypass surgery using leg vein vs PTFE are listed in the TASC II guidelines:
What this article tells us:
The authors claim that: The favourable long term results of secondary patency and limb salvage rates encourage the use of arm veins as alternative conduits for infragenicular bypass surgery.
the results are as follows:
The current research shows the following results:
and this is the abstract:
Methods
This was a retrospective study. Between 1991 and 2005. 120 infragenicular bypasses using arm vein conduits (AVCs) were performed in 120 patients. CLI was the main indication (87.5%) for the procedures. The indications for using arm veins were inadequacy or absence of the ipsilateral greater saphenous vein (GSV). Survival, limb salvage, and patency rates were calculated using the Kaplan–Meier method.
Results
There was a predominance of male gender (65%), and the group mean age was 68.1 ± 8.3 years. The mean follow-up period was 29.6 ± 26.3 months. The operative mortality (30 days) rate was 7.5%. The main alternative conduit was non-spliced cephalic vein (37.5%). Composite grafts included GSV + AVC (45.2%), AVC + AVC (43.3%) and small saphenous vein + AVC (11.5%). The 5-year primary and secondary patency (SP) rates were 45.2 ± 5.6% and 56.5 ± 5.0%, respectively. The 5-year SP rate was greatest when using non-spliced cephalic vein (65.8 ± 7.6%), but there was no difference in cumulative patency between spliced and non-spliced veins (49.5 ± 8.0% vs. 61.2 ± 6.4%; p = 0.501). The 5-year limb salvage and survival rates were 70.6 ± 5.9% and 59.6 ± 5.8%, respectively.
my comments:
There is some 10-15% improvement in 5 year patency rate. Out of 10 patients, 4-5 will keep the PTFE graft in 5 years, vs 5-6 in arm veins. If arm vein harvesting is going to be a long operation, then a PTFE with a cuff is probably more suitable. If, however, there is enough staff, and there is a higher risk of infection, then arm veins are likely to be a better alternative.