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Impact Of Preoperative Vein Mapping Diameter On Bypass Patency In Lower Extremity Revascularization
Meghana Mogalipuvvu, BS, Patrick D. Conroy, MD, Katherine McMackin, MD, Aakanksha Gupta, MD, Sarah Allen, BS, Alec Schubert, MD, Philip Batista, MD, Bruce Tjaden, MD.
Cooper University Hospital, Camden, NJ, USA.
OBJECTIVES: Greater saphenous vein (GSV) continues to be the gold-standard for lower extremity bypass conduit, specifically when the GSV is “adequate” (>3mm diameter). While landmark clinical trials, most recently BEST-CLI, utilize this definition of adequate GSV, we seek to determine if the definition is appropriate and if it confers a long-term bypass patency benefit.
METHODS: We conducted a retrospective analysis of all lower extremity bypasses using GSV with preoperative vein mapping at our institution between 2016-2023. Patients were stratified by GSV adequacy, defined as long-segment vein diameter >3mm. The primary outcome was amputation and graft-occlusion free survival. Secondary outcomes included any graft thrombosis, amputation, and death. Stata 17.0 was used to perform logistic regressions and Kaplan-Meier analyses.
RESULTS: We identified 63 patients (17 female, 46 male) who underwent lower extremity bypass with GSV. Just above half (59%) had an adequately-sized GSV. Amputation and graft-occlusion free survival was no different between those with adequate GSV and inadequate GSV (57% vs. 69%; aOR=1.75,p=0.31). Between patients with adequate GSV and those with inadequate GSV, there was no difference in graft thrombosis (58% vs. 56%; aOR=0.73,p=0.15) or amputation (27% vs. 32%; aOR=1.27,p=0.96). Kaplan-Meier analysis reveals no significant difference in long-term outcomes based on preoperative adequate vein.
CONCLUSIONS: Our results highlight no difference in lower extremity bypass long-term patency rates based on vein diameter seen on preoperative vein mapping. This highlights either the ineffectiveness of preoperative vein mapping to determine the true viability of GSV for effective bypass conduit, or an improper assignment of 3mm as the cutoff as “adequate” for use as a bypass conduit. Larger-scale investigations, involving multiple institutions, are needed before recommendations on bypass conduit selection should change. With our results, we hope to stimulate discussion on vein adequacy and to determine if we are underestimating the number of patients with veins effective for bypass.
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