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

Faries, Peter L.; LoGerfo, Frank W.; Arora, Subodh; Pulling, Michele C.; Rohan, Darren I.; Akbari, Cameron M.; Campbell, David R.; Gibbons, G. W.; Pomposelli, Frank B.

doi:10.1067/mva.2000.106488

Cited by 74 publications

(35 citation statements)

References 36 publications

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“…Of these, about 200.000 are small and medium diameter grafts (4-6mm) for vascular access and to relieve lower limb ischemia and more than 600.000 are small diameter grafts (1-4mm) needed for coronary bypass procedures. The conduit of choice for small diameter vascular graft surgery is the autologous vein or artery, but these are not available in 25-30% of patients due to preexisting conditions or previous harvesting [1]. Current grafts are made of polyethylene terephtalate (Dacron) or expanded polytetrafluoroethylene (ePTFE), or biologically derived conduits such as cryopreserved saphenous vein allografts and decellularized bovine ureters [2, 3].…”

Section: Introductionmentioning

confidence: 99%

The performance of cross-linked acellular arterial scaffolds as vascular grafts; pre-clinical testing in direct and isolation loop circulatory models

et al. 2014

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There is a significant need for small diameter vascular grafts to be used in peripheral vascular surgery; however autologous grafts are not always available, synthetic grafts perform poorly and allografts and xenografts degenerate, dilate and calcify after implantation. We hypothesized that chemical stabilization of acellular xenogenic arteries would generate off-the-shelf grafts resistant to thrombosis, dilatation and calcification. To test this hypothesis, we decellularized porcine renal arteries, stabilized elastin with penta-galloyl glucose and collagen with carbodiimide / activated heparin and implanted them as transposition grafts in the abdominal aorta of rats as direct implants and separately as indirect, isolation-loop implants. All implants resulted in high patency and animal survival rates, ubiquitous encapsulation within a vascularized collagenous capsule, and exhibited lack of lumen thrombogenicity and no graft wall calcification. Peri-anastomotic neo-intimal tissue overgrowth was a normal occurrence in direct implants; however this reaction was circumvented in indirect implants. Notably, implantation of non-treated control scaffolds exhibited marked graft dilatation and elastin degeneration; however PGG significantly reduced elastin degradation and prevented aneurismal dilatation of vascular grafts. Overall these results point to the outstanding potential of crosslinked arterial scaffolds as small diameter vascular grafts.

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Section: Introductionmentioning

confidence: 99%

The performance of cross-linked acellular arterial scaffolds as vascular grafts; pre-clinical testing in direct and isolation loop circulatory models

et al. 2014

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“…Recent studies have reported that LEAB using arm vein conduits showed 3-year graft patency and limb salvage rates ranging from 40% to 73% and 63% to 92%, respectively [8,12,13,16]. In our series, the overall 3-year patency and limb salvage rates were 60.9% and 94.4%, respectively.…”

Section: Discussionmentioning

confidence: 44%

“…Previous studies showed that results from infrapopliteal bypass using prosthetic graft have been less satisfactory than those obtained with arm vein (Table 4) [8,12,16,19–25]. In our institute, we prefer arm vein graft as a first choice of alternative graft in infrapopliteal bypass in the absence of adequate saphenous vein.…”

Section: Discussionmentioning

confidence: 86%

“…After that, several studies from the past decade have introduced good long term patency rates and limb salvage rates in lower limb bypass with arm vein conduit [8,12–16]. Some groups have encouraged the use arm veins as the first alternative conduit when the ipsilateral GSV is absent due to the low morbidity of arm vein harvesting and for preservation of the contralateral GSV [8,12,13]. These studies showed that contralateral GSVs were subsequently used for either contralateral infrainguinal limb bypass (20%–23%) or coronary bypass (2%–3%).…”

Section: Discussionmentioning

confidence: 99%

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Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review

Park

Yoon

et al. 2016

VSI

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Purpose:The superiority of autogenous vein conduits is well known in lower extremity arterial bypass (LEAB). Among various alternative conduits for LEAB, long-term results of arm vein grafts were investigated in this study.Materials and Methods:We retrospectively reviewed clinical characteristics of 28 patients who underwent infrainguinal LEAB with autogenous arm vein grafts at a single institute between January 2003 and December 2015. All procedures were performed in the absence of adequate saphenous veins. Graft patency was determined by periodic examinations with duplex ultrasonography.Results:Autologous arm vein grafts were implanted for 28 patients (mean age, 60.4±16.8 years; range, 20–82 years; male, 92.9%; atherosclerosis, 19 [67.9%]; and non-atherosclerotic disease 9 [32.1%] including 5 patients with Buerger’s disease). Source of arm vein were basilic 13 (46.4%), cephalic 4 (14.3%) and composition graft with other veins in 11 (39.3%) cases. The level of distal anastomosis was distributed as popliteal in 5 (17.9%), tibio-peroneal in 21 (75.0%) and inframalleolar artery in 2 (7.1%) cases. Mean duration of follow-up was 41.5±46.9 months (range, 1–138 months). Cumulative primary patency rates at 1, 3, and 5 years were 66.5%, 60.9% and 60.9%, respectively. Assisted-primary patency rates at 1, 3 and 5 years were 66.5%, 66.5% and 66.5%, respectively. Secondary patency rates at 1, 3 and 5 years were 70.8%, 70.8% and 70.8%, respectively. There was one limb amputation during the follow-up period.Conclusion:Arm veins are a useful alternative conduit when great saphenous veins are not available during LEAB.

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“…Second, only an autogenous vein of good quality with a large diameter must be used. Prior studies have reported unfavorable outcomes of composite prosthetic-autogenous grafts [11,23,24]; however, these studies have a possibility of selection bias, and the details of the procedures using composite grafts were not well described. Third, the operation must be performed in a planned manner.…”

Section: Discussionmentioning

confidence: 99%

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

Jin

Park

Kim

et al. 2017

VSI

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PurposeUse of a composite graft combining a polytetrafluoroethylene graft with an autogenous vein is an option for limb salvage in the absence of an adequate single segment vein graft. We aimed to investigate the results of infrainguinal bypass with a composite graft.Materials and MethodsWe retrospectively reviewed 11 infrainguinal arterial bypasses on 11 limbs which underwent surgery from March 2012 to November 2016.ResultsCritical limb ischemia was common (63.6%) indication of bypass surgery and most (90.9%) of the patients had history of failed previous treatment including endovascular treatment (36.4%) and bypass surgery (72.7%). At the 2 years after graft implantations, primary patency and amputation-free survival of below-knee bypasses using composite graft were 73% and 76%, respectively.ConclusionInfrainguinal arterial bypasses with composite graft had an acceptable patency. In patients without other alternative conduits for revascularization, bypass with a composite graft can be an option.

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

Cited by 74 publications

References 36 publications

The performance of cross-linked acellular arterial scaffolds as vascular grafts; pre-clinical testing in direct and isolation loop circulatory models

The performance of cross-linked acellular arterial scaffolds as vascular grafts; pre-clinical testing in direct and isolation loop circulatory models

Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review

Results of Infrainguinal Bypass with a Composite Graft Combining Polytetrafluoroethylene and Vein Graft in Absence of Appropriate Saphenous Vein Graft

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