Arm Vein as an Alternative Autogenous Conduit for Infragenicular Bypass in the Treatment of Critical Limb Ischaemia: A 15 Year Experience

Objectives: The value of alternative autogenous venous conduits for treating critical limb ischaemia (CLI) with infragenicular bypass surgery is well established. In this study, the results of using arm veins as alternative conduits for treating CLI over a 15-year period have been evaluated. 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. Conclusions: 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. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. Article history: Received 16 August 2013, Accepted 27 January 2014, Available online 6 March 2014