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Autologous Non Great Saphenous Veins do not Provide Better Outcomes than Prosthetic Conduits for Below-Knee Bypass
Danielle R. Doucet, MD, Efthymios D. Avgerinos, MD, Ulka Sachdev, MD, Theodore H. Yuo, MD, Rabih A. Chaer, MD, Steven A. Leers, MD, Michel S. Makaroun, MD.
UPMC Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVES: While the great saphenous vein (GSV) remains the preferred conduit for bypass procedures to below-knee targets, many patients have no usable GSV. This study aims to compare the outcomes of autologous alternative vein (AAV) to GSV and prosthetic conduits.
METHODS: Retrospective analysis was performed for consecutive patients undergoing bypasses to below-knee target vessels for arterial occlusive disease between 1/07-12/09. Patients were categorized into three groups according to the conduit utilized: GSV; AAV(small saphenous veins, arm veins or spliced vein segments); Prosthetic. Indications, demographics, and runoff scores were recorded. Chi-squared tests were utilized to evaluate 30 day major adverse limb and cardiac events (MALE and MACE) within each group. Patency rates and one year outcomes were evaluated by Kaplan-Meier analysis. Multivariate analysis was used to control for confounding factors.
RESULTS: 240 patients were treated (97% critical limb ischemia). Targets included below knee popliteal (28%, n=67), tibial (57%, n=137) and pedal (15%, n=36) vessels. Conduits included GSV (54%), AAV (30%) and prosthetic (16%). The groups were similar in all baseline characteristics including runoff scores with the exception of lower incidence of diabetes in the prosthetic group. The 30 day MALE and MACE scores and wound complications rates were not affected by type of conduit. One year RAO ( major revision or amputation), RAS (major revision, amputation or stenosis requiring angioplasty) and amputation free survival were also similar between groups. Log rank comparisons of one year patency for the three groups (GSV, AAV, Prosthetic) showed significant difference in primary patency (60%, 34% and 56%; p=0.001) and primary assisted patency (79%, 61%, 59%; p=0.001), but similar secondary patency (79%, 69%, 59%; p=0.055). At two years, AAV has considerably poorer primary patency than prosthetic and is not superior with regards to primary assisted and secondary patency. Multivariate analysis identified the AAV conduit as an independent risk factor for loss of primary patency at one and two years.
CONCLUSIONS: AAV does not offer any significant advantage over a prosthetic bypass for below knee targets when GSV is not available.
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