The use of arm veins as peripheral vascular grafts.

Below-knee femoro-popliteal and especially femoro-distal bypass with nonautologous bypass material is met with poor patency rates. During an eight-year period, nine (composite) arm-vein grafts were done in eight patients. In only one patient, the arm-vein bypass was a primary procedure. In four patients this concerned a secondary procedure and in four a tertiary procedure. All eight patients demonstrated critical ischaemia of the affected limb. Distal anastomosis involved the below-knee popliteal artery in three cases and the tibial artery in the remainder six. In all but one case runoff was poor to extremely poor. Notwithstanding these unfavourable characteristics, eight out of nine bypasses have remained patent after a mean follow-up of 29 months (range five to 72 months). The only bypass that occluded did so without any symptoms or effect on the viability of the foot. In four patients, the arm veins were too narrow for grafting. Four to six weeks after construction of an arteriovenous fistula at the wrist their arm veins were at least partially suitable for grafting.