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Distal Anastomotic Vein Cuff Usage in Prosthetic Bypasses: A Vascular Study Group of New England Study
James T. McPhee, MD1, Phillip P. Goodney, MD2, Andres Schanzer, MD3, Michael Belkin, MD1, Matthew T. Menard, MD1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 3University of Massachusetts Medical Center, Worcester, MA, USA.

OBJECTIVES:Single-segment saphenous vein remains the optimal conduit for infra-inguinal revascularization. In its absence, prosthetic conduit may be used. Existing data regarding the significance of adjunctive distal vein cuff (DVC) usage with prosthetic grafts are based on small series.
METHODS: This is a retrospective cohort analysis derived from the regional Vascular Study Group of New England, 2003-2010. 1018 infrainguinal prosthetic bypass grafts were captured in the dataset from 73 surgeons at 15 participating institutions. Outcome measures of interest included: primary patency, freedom from major adverse limb events (MALE), and amputation free survival (AFS) at 1 year as a function of vein patch utilization.
RESULTS: Of the 1018 bypass operations, 94 (9.2%) had a DVC while 924 (90.8%) did not (no DVC). The DVC and no DVC group had many similar baseline comorbid characteristics (Table). Likewise, they had similar rates of preoperative independent living (93.6% vs. 95.7%, p=0.43) and independent ambulation (70.2% vs. 76.5%, p=0.2). A higher proportion of the DVC group had a CLI indication (73.4% vs. 60.3%, p=0.01), had a prior bypass (58.5% vs. 37.9%, p=0.014), were on hemodialysis (11.7% vs. 5.8%, p=0.003) or had a more distal target vessel (p<.0001). The DVC group had a higher rate of completion angiogram performed (56.4% vs. 42.6%, p=0.01). At 1 year the DVC and no DVC groups had similar rates of primary patency, freedom from MALE and AFS (Table).
CONCLUSIONS: This contemporary multi-institutional study demonstrates that patients that receive distal anastomotic vein cuffs as part of infrainguinal prosthetic bypass operations in general have higher risk comorbidities and more technically challenging operations based on level of target vessel and prior bypass attempts. The use of a DVC may improve outcomes for disadvantaged grafts to a level similar to that for grafts with more favorable features.
Baseline Characteristics and 1 year outcomes for prosthetic infrainguinal bypasses
Distal Vein CuffNo Distal Vein CuffP-Value
Mean Age [±Stddev]70.5[10.8]68.8[11.1]0.17
% Male Gender54.364.20.07
%Below-knee target78.742.5<0.0001
%Diabetes58.548.80.08
%on Hemodialysis11.75.80.003
% Critical Limb Ischemia Indication73.460.30.01
Primary Patency at 1 year71.3±5.771.1±2.00.73
Freedom from MALE80.4±4.879.9±1.80.45
Amputation free Survival60.0±6.771.8±2.60.067


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