Arm vein conduit vs prosthetic graft in infrainguinal revascularization for critical leg ischemia

Arvela, E.; Söderström, Mats; Albäck, Anders; Aho, Pekka-Sakari; Venermo, Maarit; Lepäntalo, Mauri

doi:10.1016/j.jvs.2010.04.013

Cited by 72 publications

(41 citation statements)

References 38 publications

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“…Whereas the addition of a venous interposition cuff to a prosthetic graft may provide a minor benefit, 28-30 we were limited in drawing significant statistical conclusions from the use of these and the aforementioned bypass conduit choices. Many investigators, however, have shown promising results with such alternative conduit choices 31-33 and further studies focusing on their effectiveness are in progress within our region. Second, the patient cohort studied was predominantly Caucasian.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Suckow

Kraiss

Stone

et al. 2013

Annals of Vascular Surgery

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Background The autogenous vein is the preferred conduit in below-knee vascular reconstructions. However, many argue that prosthetic grafts can perform well in crural bypass with adjunctive antithrombotic therapy. We therefore compared outcomes of below-knee prosthetic versus autologous vein bypass grafts for critical limb ischemia and the use of adjunctive antithrombotic therapy in both settings. Methods Utilizing the registry of the Vascular Study Group of New England (2003–2009), we studied 1227 patients who underwent below-knee bypass for critical limb ischemia, 223 of whom received a prosthetic graft to the below-knee popliteal artery (70%) or more distal target (30%). We used propensity matching to identify a patient cohort receiving single-segment saphenous vein yet had remained similar to the prosthetic cohort in terms of characteristics, graft origin/target, and antithrombotic regimen. Main outcome measures were graft patency and major limb amputation within 1 year. Secondary outcomes were bleeding complications (reoperation or transfusion) and mortality. We performed comparisons by conduit type and by antithrombotic therapy. Results Patients receiving prosthetic conduit were more likely to be treated with warfarin than those with greater saphenous vein (57% vs. 24%, P < 0.001). After propensity score matching, we found no significant difference in primary graft patency (72% vs. 73%, P = 0.81) or major amputation rates (17% vs. 13%, P = 0.31) between prosthetic and single-segment saphenous vein grafts. In a subanalysis of grafts to tibial versus popliteal targets, we noted equivalent primary patency and amputation rates between prosthetic and venous conduits. Whereas overall 1-year prosthetic graft patency rates varied from 51% (aspirin + clopidogrel) to 78% (aspirin + warfarin), no significant differences were seen in primary patency or major amputation rates by antithrombotic therapy (P = 0.32 and 0.17, respectively). Further, the incidence of bleeding complications and 1-year mortality did not differ by conduit type or antithrombotic regimen in the propensity-matched analysis. Conclusions Although limited in size, our study demonstrates that, with appropriate patient selection and antithrombotic therapy, 1-year outcomes for below-knee prosthetic bypass grafting can be comparable to those for greater saphenous vein conduit.

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Section: Discussionmentioning

confidence: 99%

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Suckow

Kraiss

Stone

et al. 2013

Annals of Vascular Surgery

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“…Existing data evaluating prosthetic conduits (PCs) vs alternative vein (AV) sources (arm vein, small saphenous vein, composite/spliced vein segments) in the absence of usable SSGSV are limited and report mixed results. 4,5 The purpose of this study was to evaluate the optimal conduit for below-knee popliteal artery bypass in the absence of usable SSGSV.…”

mentioning

confidence: 99%

Optimal conduit choice in the absence of single-segment great saphenous vein for below-knee popliteal bypass

McPhee

Barshes

Ozaki

et al. 2012

Journal of Vascular Surgery

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For patients with inadequate SSGSV, PCs, with varying degrees of medical and surgical adjuncts, appear comparable to AV sources in graft patency for below-knee popliteal bypass targets. This observation is tempered by the small cohort sample size of this single-institutional analysis. Critical limb ischemia as the operative indication and current hemodialysis predict impaired patency, and hemodialysis is associated with limb loss.

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“…For distal targets, such as IPA, we recommend the use of AAC, which is supported by this study as well as others. 20,[24][25][26] In the future, randomized, prospective studies are needed to compare the efficacy of NAC over AAC and, possibly, GSV. We are currently in the process of performing similar analyses on the larger Vascular Quality Initiative database, which may also allow for better evaluation of subgroups.…”

Section: Discussionmentioning

confidence: 99%

Alternative conduit for infrageniculate bypass in patients with critical limb ischemia

Moreira

Leung

Farber

et al. 2016

Journal of Vascular Surgery

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Arm vein conduit vs prosthetic graft in infrainguinal revascularization for critical leg ischemia

Abstract: Arm vein conduits, even when spliced, are superior to prosthetic grafts in terms of midterm assisted primary patency, secondary patency, and leg salvage in infrapopliteal bypasses for CLI.

Cited by 72 publications

References 38 publications

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Comparison of Graft Patency, Limb Salvage, and Antithrombotic Therapy Between Prosthetic and Autogenous Below-Knee Bypass for Critical Limb Ischemia

Optimal conduit choice in the absence of single-segment great saphenous vein for below-knee popliteal bypass

Alternative conduit for infrageniculate bypass in patients with critical limb ischemia

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