Optimizing infrainguinal arm vein bypass patency with duplex ultrasound surveillance and endovascular therapy

Abstract

Arm veins used in lower limb bypass procedures are prone to development of stenosis and aneurysm, lesions easily detected with a life-long duplex ultrasound surveillance program. Excellent long-term patency (91%) was achieved despite graft intervention being performed in nearly half of all bypasses and one third of revised grafts. Endovascular treatment was possible in half of all graft stenosis, with outcomes similar to those with surgical repair.

Femoro-Distal Bypass with Varicose Veins Covered by Prosthetic Mesh

“…In addition, arm vein grafts are typically prone to develop aneurism or other graft problems at a rate of up to 55% [8]. In the present study, all patients had surgery to treat CLI, acute ischemia, or popliteal aneurisms.…”

“…In addition, the basilic vein, taken from the upper limb, is usually thinly walled and has a large diameter; therefore, it is susceptible for longterm dilatation [7,8]. These situations are usually a contraindication to autologous vein grafting due to the increased formation of intimal hyperplasia and dilatation, which could lead to aneurism formation and thrombus apposition [9][10][11][12][13].…”

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

“…There are several series from the past decade reporting excellent longterm results in infrainguinal bypasses using arm vein as a conduit. 5,15,16,21 The low morbidity related to arm vein harvest and good long-term patency have even encouraged some groups 5,15,16 to use arm veins as the first alternative when the ipsilateral GSV is absent. The rationale for this is the avoidance of wound problems in donor limbs and preservation of CGSV for subsequent contralateral limb revascularization or CABG.…”

Balloon angioplasty for revision of failing lower extremity bypass grafts

“…However, the efficacy of this treatment modality, first described by Alpert et al, 19 remains unclear. 1,17,[20][21][22][23] The aim of this study was to report our experience on the efficacy and safety of balloon angioplasty as the primary method of intervention in patients with CDU-documented failing bypass grafts and to determine factors that may affect the patency of percutaneous transluminal angioplasty (PTA)-revised lower extremity bypass grafts and the subsequent need for multiple revisions.…”