Journal of vascular surgery · 2026
Contemporary assessment of great saphenous vein adequacy in patients with chronic limb-threatening limb ischemia.
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Farber Elina H, Farber Alik, King Elizabeth, Talutis Stephanie, Kalish Jeffrey A, Alonso Andrea, Maaneb De Macedo Khu Aten, Estrella Josue, Siracuse Jeffrey J
Аннотация
OBJECTIVE: In patients with chronic limb-threatening ischemia (CLTI), the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial demonstrated a significant benefit of infrainguinal bypass with single-segment great saphenous vein (GSV). Given the rise of venous ablation and the lack of consistent vein mapping, the prevalence of adequate GSV is poorly defined in current patients with CLTI. Our goal was to assess the availability of adequate GSV in a contemporary CLTI population.
METHODS: We conducted a single-center review of unique patients with CLTI (2016-2025) who had vein mapping before an open or endovascular intervention was performed. Patients with a history of prior open infrainguinal revascularizations were excluded. Duplex ultrasound reports were evaluated for GSV diameter. Vein diameter was assessed for a minimum of 2.5 mm throughout the thigh alone and 3 mm throughout the entire leg (thigh and calf). Ipsilateral and contralateral measurements were recorded. Patient and anatomical details were compared and stratified by available GSV.
RESULTS: We identified 223 patients. The patients had a mean age of 68.6 years; 64.1% were male, 50.2% were of Black race, and 17.9% were of Hispanic ethnicity. The majority (69.1%) had diabetes mellitus, and 35% were currently smoking. Of these patients, 16.6% had a history of deep vein thrombosis, 18.4% had chronic venous insufficiency, and 0.9% had a prior GSV ablation; 29.1% had a prior ipsilateral infrainguinal endovascular intervention. With respect to duplex-based measurements, thigh GSV ≥2.5 mm alone was seen in 69.5% and 74% of the ipsilateral and either leg, respectively. Entire leg GSV ≥2.5 mm was observed in 42.9% and 46.6% of the ipsilateral and either leg, respectively. Thigh GSV ≥3 mm alone was seen in 58.7% and 64.6% of the ipsilateral and either leg, respectively. Entire leg GSV ≥3 mm was observed in 23.8% and 27.4% of the ipsilateral and either leg, respectively. Overall, 102 patients (45.7%) underwent femoropopliteal intervention, including 46 endovascular (20.6%) and 56 bypass (25.1%) procedures. Among patients undergoing femoropopliteal intervention, 153 (68.6%) had a thigh GSV diameter of ≥2.5 mm and 133 (59.8%) had a diameter of ≥3.0 mm. Male gender (odds ratio, 2.32; 95% confidence interval, 1.28-4.24; P = .006) and diabetes mellitus (odds ratio, 2.17; 95% confidence interval, 1.15-4.1; P = .02) were associated with >2.5 mm vein diameter on multivariable analysis.
CONCLUSIONS: The majority of patients with CLTI had adequate thigh GSV, with a high percentage having adequate GSV throughout the entire leg. These findings suggest that a significant number of patients fit for revascularization could be candidates for a single-segment GSV bypass.
METHODS: We conducted a single-center review of unique patients with CLTI (2016-2025) who had vein mapping before an open or endovascular intervention was performed. Patients with a history of prior open infrainguinal revascularizations were excluded. Duplex ultrasound reports were evaluated for GSV diameter. Vein diameter was assessed for a minimum of 2.5 mm throughout the thigh alone and 3 mm throughout the entire leg (thigh and calf). Ipsilateral and contralateral measurements were recorded. Patient and anatomical details were compared and stratified by available GSV.
RESULTS: We identified 223 patients. The patients had a mean age of 68.6 years; 64.1% were male, 50.2% were of Black race, and 17.9% were of Hispanic ethnicity. The majority (69.1%) had diabetes mellitus, and 35% were currently smoking. Of these patients, 16.6% had a history of deep vein thrombosis, 18.4% had chronic venous insufficiency, and 0.9% had a prior GSV ablation; 29.1% had a prior ipsilateral infrainguinal endovascular intervention. With respect to duplex-based measurements, thigh GSV ≥2.5 mm alone was seen in 69.5% and 74% of the ipsilateral and either leg, respectively. Entire leg GSV ≥2.5 mm was observed in 42.9% and 46.6% of the ipsilateral and either leg, respectively. Thigh GSV ≥3 mm alone was seen in 58.7% and 64.6% of the ipsilateral and either leg, respectively. Entire leg GSV ≥3 mm was observed in 23.8% and 27.4% of the ipsilateral and either leg, respectively. Overall, 102 patients (45.7%) underwent femoropopliteal intervention, including 46 endovascular (20.6%) and 56 bypass (25.1%) procedures. Among patients undergoing femoropopliteal intervention, 153 (68.6%) had a thigh GSV diameter of ≥2.5 mm and 133 (59.8%) had a diameter of ≥3.0 mm. Male gender (odds ratio, 2.32; 95% confidence interval, 1.28-4.24; P = .006) and diabetes mellitus (odds ratio, 2.17; 95% confidence interval, 1.15-4.1; P = .02) were associated with >2.5 mm vein diameter on multivariable analysis.
CONCLUSIONS: The majority of patients with CLTI had adequate thigh GSV, with a high percentage having adequate GSV throughout the entire leg. These findings suggest that a significant number of patients fit for revascularization could be candidates for a single-segment GSV bypass.