Arm Vein Is Superior To Polytetrafluoroethylene In Infrainguinal Bypass To The Tibial Vessels

Document Type

Conference Proceeding

Publication Date

3-1-2025

Publication Title

Ann Vasc Surg

Keywords

polytetrafluoroethylene, amputation, conference abstract, controlled study, drug combination, female, human, major clinical study, male, polytetrafluoroethylene implant, popliteal artery, reoperation, saphenous vein, thrombectomy, tibia, tibial artery

Abstract

Introduction and Objectives: When single-segment great saphenous vein (ssGSV) is unavailable, commonly used conduits include alternative source autologous veins and polytetrafluoroethylene (PTFE). This study aims to compare the outcomes of arm veins and PTFE in infrainguinal bypass (IIB). Methods: Patients undergoing an IIB from a femoral origin between 2003-2023 were identified in the VQI. Patients who received an arm vein were 1:3:3 propensity-matched with those who received ssGSV and PTFE respectively. Cox-regression was used to evaluate the long-term outcomes of patency, amputation, reoperation, and major adverse limb events (MALE). Results: 894 patients undergoing IIB using an arm vein (73% single segment, 27% spliced) were matched to 2,682 patients receiving ssGSV and 2,682 patients receiving PTFE. The three groups were similar in all baseline characteristics. When the popliteal artery is the distal outflow site, arm veins and PTFE exhibited similar primary patency (67% vs 73%, p=0.074), primary-assisted patency (83% vs 78%, p=0.270), and secondary patency (86% vs 87%, p=0.605) at 1-year. When a tibial artery is the distal outflow site, arm veins had similar primary patency (63% vs 65%, p=0.460), but higher primary-assisted patency (80% vs 70%, p<0.001) and secondary patency (83% vs 77%, p=0.009) compared to PTFE at 1-year. Using an arm vein for a femoral-to-tibial bypass was associated with a 61% decrease in the risk of amputation (HR 0.39 [0.27-0.56], p<0.001), 53% decrease in thrombectomy/lysis to re-establish patency (HR 0.47 [0.30-0.74], p=0.001), and 30% decrease in the loss of secondary patency (HR 0.70 [0.54-0.92], p=0.009) compared to using PTFE. No difference was observed between single-segment and spliced arm vein. Conclusions: Arm vein for femoral-to-tibial bypass is associated with higher long-term patency and lower amputation rates compared to PTFE. In the absence of a suitable ssGSV, using an arm vein should be considered before resorting to a PTFE graft.

Volume

112

First Page

425

Last Page

426

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