Outcomes After Utilization of Autogenous Arm Vein Grafts for Lower Extremity Bypasses.

BACKGROUND

Lower extremity bypasses performed with autogernous conduit have superior patency and limb salvage. This is often performed with single segment great saphenous vein (GSV), but other options may be required for patients without available GSV. This study presents our experience utilizing arm veins as an alternative autogenous conduit for patients undergoing lower extremity bypass procedures.

METHODS

A single-center retrospective study of patients at a Veterans Affairs Medical Center with peripheral arterial disease (PAD) who underwent lower extremity bypass with arm vein between January 2009 and July 2023 was performed. The primary outcomes were amputation-free survival (AFS) and major adverse limb event (MALE). Secondary outcomes include postoperative complications, such as postoperative surgical site infection, total hospital length of stay, 30-day mortality, and unplanned 30-day readmission.

RESULTS

From January 2009 to June 2023, there were 42 lower extremity bypasses performed in patients who possessed inadequate GSV. All procedures were performed in men (n = 42, 100%). The median age was 67 years (interquartile range (IQR) 62-71 years). Nine procedures (21.4%) were performed for claudication, 21 (50%) for tissue loss, and 12 (28.6%) for rest pain. The majority involved bypassing to infrageniculate targets (n = 39, 93%). Conduit composition included single (n = 19, 45%), two-piece (n = 19, 45%), or three-piece (n = 4, 10%) composite grafts with arm vein. The median AFS was 3.86 years (IQR 1.19-6.65 years). Five patients required major amputation (15.6%). The median time to MALE was 0.88 years (IQR 0.23-1.69 years). Overall, 30-day mortality was 2.4% (n = 1). Postoperative complications included surgical site infection in 9 patients (21.4%), hematoma in 3 patients (7.1%), early graft thrombosis in one patient (2.4%), wound dehiscence in one patient (2.4%), and a lymph leak in one patient (2.4%). The median length of stay was 6 days (IQR 3.3-9.5 days).

CONCLUSION

Arm vein is a viable alternative autogenous conduit for lower extremity arterial bypasses in patients without adequate GSV.