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Contemporary Assessment Of Adequate Great Saphenous Vein In Patients With Chronic Limb Threatening Limb Ischemia
Hashim HTH Manea, MD.
Oregon Health and Science University, Portland, OR, USA.
OBJECTIVES: In patients with chronic limb threatening ischemia (CLTI), the BEST-CLI trial showed the benefit of using single segment great saphenous vein (GSV) for infrainguinal bypass. Given rising venous interventions and inconsistent vein mapping, prevalence of adequate GSV is poorly defined in current patients. We assessed the availability of adequate GSV in a contemporary CLTI population.
METHODS: A single center review of unique CLTI patients (2016-2025) with vein mapping before open or endovascular intervention was performed. Patients with prior open revascularization were excluded. Our practice was to generally perform mapping for candidates considered for open revascularization. Ipsilateral and contralateral vein was assessed for a minimum diameter of 2.5 and 3 mm throughout the thigh and the entire leg, without intraluminal defects.
RESULTS: We identified 223 patients with an average age of 68.6 years: 64.1% were male, 50.2% were Black and 17.9% were Hispanic.The majority (69.1%) had diabetes and 35% were current smokers. Of these patients, 16.6% had a history of deep vein thrombosis, 18.4% had chronic venous insufficiency, 0.9% had a prior GSV ablation, and 29.1% had a previous ipsilateral infrainguinal endovascular intervention.Thigh GSV ≥2.5 mm alone was seen in 69.5% and 74% of the ipsilateral and either leg, respectively. Thigh + calf GSV ≥2.5 mm was observed in 42.9% and 47.5% ipsilateral and either leg, respectively. Thigh GSV ≥3 mm alone was seen in 58.7% and 64.6% of ipsilateral and either leg, respectively. Thigh + calf GSV ≥3 mm was observed in 24.2% and 27.9% of ipsilateral and either leg, respectively. Of the 223 patients, 45.7% had femoropopliteal interventions (45% endovascular and 55% bypass); 68.6% had GSV ≥2.5 mm and 59.8% had GSV ≥3 mm in the thigh. Patients with GSV ≥3mm were likely to be younger and be current smokers (P<.05). No predictive factors were significant on multivariable analysis.
CONCLUSIONS: Among patients with CLTI who are judged to be candidates for bypass, almost 3/4 and 1/2 had adequate thigh and entire leg GSV, respectively. These findings suggest that a significant number of patients fit for revascularization could be candidates for a single segment GSV bypass.
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