Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization

Purpose: Various alternative conduits have been used for lower extremity re vascularization when an adequate ipsilateral greater saphenous vein is abse nt. This study compared the effectiveness of all-autogenous multisegment ar m vein bypass grafts with that of composite grafts composed of combined pro sthetic and autogenous conduits. Methods: One hundred fifty-three lower extremity revascularization procedur es per formed between 1990 and 1998 were followed up prospectively using a computerized vascular registry. The grafts were composed of spliced arm vei n segments with venovenostomy in 122 and of composite prosthetic-autogenous conduit in 31. Arm vein conduit was prepared by means of intraoperative an gioscopy for valve lysis and identification of luminal abnormalities in 47. 7% of cases. Results: Bypass graft configurations were as follows: femoropopliteal (12 a rm vein, 2 composite); femorotibial (75 arm vein, 23 composite); femoropeda l (14 arm vein, 6 composite), and popliteo-tibial/pedal (21 arm vein, 0 com posite). The indication for surgery was limb salvage in 98% and disabling d audication in 2% of cases. The mean follow-up was 25.1 months (range, 1 mon th to 7.9 years). Overall survival at 4 years was 51%. Overall patency and limb salvage rates were as follows: primary patency, at 1 year-arm vein, 76 .9% +/- 4.8%; composite, 59.5% +/- 9.6% (P = .02); at 3 years-arm vein, 70. 0% +/- 8.0%; composite, 43.7% +/- 12.4% (P < .01); and at 5 years-arm vein, 53.8% +/- 8.7%; composite, 0%; secondary patency, at 1 year-arm vein, 77.5 % +/- 4.6%; composite, 59.8% +/- 9.5% (P = .02); at 3 years-arm vein, 70.7% a 7.5%, composite, 44.9% +/- 13.1% (P < .01); at 5 years-arm vein, 57.7% /- 8.0%; composite, 0%; limb salvage, at 1 year-arm vein, 89.3% +/- 3.7%; c omposite, 73.9% +/- 8.9% (P < .01); at 3 years-arm vein, 80.5% +/- 7.0%; co mposite, 49.6% +/- 14.3% (P < .01); at 5 years-arm vein, 76.3% +/- 9.9%; co mposite, 0%. Conclusion: In this study, multisegment autogenous arm vein was used succes sfully in a wide variety of lower extremity revascularization procedures an d achieved good long-term patency and limb salvage rates, well in excess of those achieved with composite prosthetic-autogenous grafts. The use of aut ogenous conduit appears to offer superior results to composite conduit in l ower extremity revascularization. The superior durability of arm vein makes it one of the alternative conduits of choice when an adequate greater saph enous vein is not available.