Autogenous composite vein bypass graft for infrainguinal arterial reconstruction

Purpose: Lower extremity arterial reconstruction in the absence of adequate greater saphenous vein remains a challenging problem in contemporary vascu lar practice. The purpose of this review is to evaluate the long-term resul ts of autogenous composite vein grafts used for infrainguinal arterial bypa ss grafting. Methods: We retrospectively evaluated a prospective vascular registry and r eviewed inpatient and office records. Results: From Tune 1983 to September 1999, 165 autogenous composite vein in frainguinal bypass grafts were performed in 154 patients (87 men, 67 women; mean age, 69 years). The mean follow-up was 25 months (range, 3-147). Pati ents had the usual risk factors, including a 30% incidence of prior coronar y bypass grafting. Forty-eight percent of bypass grafts were performed afte r failed previous reconstructions, and 90% were performed for limb salvage. The conduits were comprised of 2 segments (75%), 3 segments (23%), and 4 s egments (2%). The distal anastomosis was at the popliteal level in 17% and the tibial/pedal level in 83%. The 30-day operative mortality rate was 1.8% . Perioperative graft failure (< 30 days) occurred in 18 bypass grafts (11% ), resulting in early amputation (< 30 days) in 1.2%. The overall 5-year cu mulative patency rates were 44% +/- 5% for primary patency, 63% +/- 5% for primary assisted patency (PAP), and 65% +/- 5% for secondary patency (SP). A high revision rate for stenosis or thrombosis was required during follow- up to maintain patency of the grafts (27%). Limb salvage was 81% +/- 5% at 5 years. Primary reconstructions with composite vein fared significantly be tter than secondary reconstructions (SP 76% vs 54% at 5 years, P < .01). Ar m vein composites showed superior patency compared with greater saphenous V ein composites (SP 79% vs 61% at 5 years, P < .05). Conclusions: Infrainguinal reconstruction with autogenous composite vein re sults in durable graft patency and Limb salvage rates in patients with few alternatives for revascularization. Intensive graft surveillance with aggre ssive graft revision is necessary to achieve these results.