Abstract：
BACKGROUND: Alternative autologous veins can be used as a conduit when adequate great saphenous vein is unavailable. We analyzed the results of our infrainguinal bypasses after adopting upper extremity veins in our practice.
METHODS: This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023.
RESULTS: During the study period, 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% ± 3.5%, 84.8% ± 5.9%, and 80.6% ± 6.9%, and secondary patency (SP) rates were 95.8% ± 2.9%, 89.2% ± 5.3%, and 89.2% ± 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). Two-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%.
CONCLUSIONS: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single-segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.
METHODS: This is a single-center observational study involving all patients whose infrainguinal bypass involved the use of upper extremity veins between April 2019, when we began using arm veins, and February 2023.
RESULTS: During the study period, 49 bypasses were done in 48 patients; mean age 68.1 ± 9.8; men 32 (66.7%); body mass index 28.0 ± 4.8; indications for surgery: chronic limb threatening ischemia 41 (83.7%); acute limb ischemia 3 (6.1%); complications of previous prosthetic 3 (6.1%), or autologous 2 (4.1%) bypass grafts. Vein splicing was used in 43 (87.8%) bypasses with 3-segment grafts being the most common (26; 53.1%). There were 24 (49.0%) femorotibial, 11 (22.4%) femoropopliteal, 9 (18.4%) femoropedal, and 5 (10.2%) extension jump bypass procedures. Eighteen (36.7%) operations were redo surgeries. Twenty-one (42.9%) bypasses were formed using only arm veins. The median follow-up was 12.9 months (4.5-24.2). Two bypasses occluded during the first 30 postoperative days (2/49; 4.1%). Overall 30-day, 1-year, and 2-year primary patency rates were 93.7% ± 3.5%, 84.8% ± 5.9%, and 80.6% ± 6.9%, and secondary patency (SP) rates were 95.8% ± 2.9%, 89.2% ± 5.3%, and 89.2% ± 5.3%. One-segment grafts had better patencies than 2-, 3-, and 4-segment grafts (1-year SP 100% ± 0% vs 87.6% ± 6.0%). Two-year amputation-free survival was 86.8% ± 6.5%; 2-year overall survival was 88.2% ± 6.6%.
CONCLUSIONS: Integration of arm vein grafts in infrainguinal bypass practice can be done safely with low incidences of perioperative graft failure. One-segment grafts had better patencies than spliced vein grafts. The achieved early patency and amputation-free survival rates strongly encourage their use. In the absence of a single-segment great saphenous vein, upper extremity vein grafts should be the preferred conduit choice.
摘要：
目的：当没有足够的大隐静脉时，可以使用替代自体静脉作为导管。我们在实践中采用上肢静脉后，分析了腹股沟下旁路的结果。
方法：这是一项单中心观察性研究，涉及所有在2019年4月之间使用上肢静脉的患者，2023年2月。
结果：在研究期间，48例患者进行了49次旁路手术；平均年龄68.1±9.8；男性32（66.7％）；体重指数28.0±4.8；手术适应症：慢性威胁肢体缺血41（83.7％）；急性肢体缺血3（6.1％）；以前的假体3（6.1％）或自体2（4.1％）旁路移植的并发症。静脉剪接用于43（87.8％）旁路，其中3段移植物最常见（26；53.1％）。股骨胫骨24例（49.0%），11（22.4%）股—————————————————————————————————————————————————————————————————————————————————————9（18.4%）股骨踏板，和5（10.2％）扩展跳转旁路程序。18例（36.7%）手术是重新手术。仅使用臂静脉形成21个（42.9％）旁路。中位随访时间为12.9个月(4.5-24.2)。在术后前30天阻塞了两个旁路（2/49；4.1％）。总体30天,1年,2年,原发通畅率为93.7%±3.5%;84.8%±5.9%;80.6%±6.9%,二次通畅率（SP）为95.8%±2.9%；89.2%±5.3%；89.2%±5.3%。1段移植物的通畅性比2-更好，3-,和4段移植物（1年SP100％±0％vs87.6％±6.0％）。2年无截肢生存率为86.8%±6.5%；2年总生存率为88.2%±6.6%。
结论：臂静脉移植物在腹股沟下旁路手术中的整合可以安全地完成，围手术期移植物失败的发生率低。单段移植物比拼接静脉移植物具有更好的通畅性。获得的早期通畅性和无截肢生存率强烈鼓励其使用。在没有单段大隐静脉的情况下，上肢静脉移植物应该是首选的导管选择。
方法：这是一项单中心观察性研究，涉及所有在2019年4月之间使用上肢静脉的患者，2023年2月。
结果：在研究期间，48例患者进行了49次旁路手术；平均年龄68.1±9.8；男性32（66.7％）；体重指数28.0±4.8；手术适应症：慢性威胁肢体缺血41（83.7％）；急性肢体缺血3（6.1％）；以前的假体3（6.1％）或自体2（4.1％）旁路移植的并发症。静脉剪接用于43（87.8％）旁路，其中3段移植物最常见（26；53.1％）。股骨胫骨24例（49.0%），11（22.4%）股—————————————————————————————————————————————————————————————————————————————————————9（18.4%）股骨踏板，和5（10.2％）扩展跳转旁路程序。18例（36.7%）手术是重新手术。仅使用臂静脉形成21个（42.9％）旁路。中位随访时间为12.9个月(4.5-24.2)。在术后前30天阻塞了两个旁路（2/49；4.1％）。总体30天,1年,2年,原发通畅率为93.7%±3.5%;84.8%±5.9%;80.6%±6.9%,二次通畅率（SP）为95.8%±2.9%；89.2%±5.3%；89.2%±5.3%。1段移植物的通畅性比2-更好，3-,和4段移植物（1年SP100％±0％vs87.6％±6.0％）。2年无截肢生存率为86.8%±6.5%；2年总生存率为88.2%±6.6%。
结论：臂静脉移植物在腹股沟下旁路手术中的整合可以安全地完成，围手术期移植物失败的发生率低。单段移植物比拼接静脉移植物具有更好的通畅性。获得的早期通畅性和无截肢生存率强烈鼓励其使用。在没有单段大隐静脉的情况下，上肢静脉移植物应该是首选的导管选择。
