Improved graft patency and altered remodeling in infrainguinal vein graft reconstruction for aneurysmal versus occlusive disease

Purpose: This study attempted to determine whether autogenous vein used for infrainguinal reconstruction in patients with aneurysmal disease might dem onstrate an altered adaptive response compared with those patients who unde rwent reconstructive surgery for occlusive disease, potentially altering gr aft patency. Methods: From 1974 to 1997, 43 patients underwent vein grafting for 60 popl iteal artery aneurysms (PAA). Results: In an attempt to monitor early vein graft adaptation, serial graft surveillance by Duplex ultrasound scan was performed in a statistically va lid subset of age-, sex-, and distal anastomotic site-matched patients with PAA and patients with occlusive disease (OD; n = 8 PAA; n = 8 OD). Compare d with an age-matched and sex-matched cohort of patients (n = 60 grafts in each group) with occlusive disease and who had femoral below-knee bypass gr afts (FBP) only, patients undergoing infrainguinal reconstruction for PAA h ad a higher 5-year primary graft patency (92% +/- 4% for PAA vs 66% +/- 7% for FBP; P < .01). Duplex surveillance demonstrated a progressive increase in arterialized vein graft diameter in the PAA group versus the OD group. I n univariant analysis, aneurysmal disease was a significant predictor of fi nal follow-up diameter (P = .002). In a linear regression model, controllin g for diameter at first follow-up after bypass grafting, first follow-up di ameter was also predictive of final follow-up diameter Conclusion: These data suggested altered remodeling of vein grafts in patie nts with popliteal artery aneurysm, which may have a beneficial effect on p atency.