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ORIGINAL ARTICLE  RECENT DEVELOPMENTS IN THE MANAGEMENT OF CRITICAL LIMB ISCHEMIA 

The Journal of Cardiovascular Surgery 2019 December;60(6):686-92

DOI: 10.23736/S0021-9509.19.11110-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of infragenicular spliced vein bypass surgery in patients with chronic limb-threatening ischemia: single center long-term results

Patricia A. van MIERLO, Wouter J. BEKKERS, Freek R. van 't LAND, Arjen G. van MIERLO, André A. de SMET, Bram FIOOLE

Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands



BACKGROUND: In patients requiring infrageniculate surgical revascularization a single-segment great saphenous vein (SS-GSV) is the optimal conduit. In the absence of a SS-GSV, the small saphenous vein and arm veins can also be used to obtain an all-autologous bypass. The aim of this study was to compare the long-term results of infrageniculate SS-GSV bypasses and spliced vein bypasses in patients with chronic limb-threatening ischemia (CLTI).
METHODS: A total of 308 consecutive CLTI patients who underwent a primary infragenicular, autologous bypass between January 2000 and December 2016 were included. The definition of a spliced vein bypass was a graft consisting of at least two venous segments.
RESULTS: A SS-GSV graft was used in 235 patients, and a spliced vein graft was used in 73 patients. Significantly more infrapopliteal bypasses were performed in the spliced vein group (P=0.024), and in this group the mean operation time was almost 60 minutes longer (P<0.001). The overall morbidity rate was 44%. The overall 30-day mortality was 3.2%, and overall in-hospital mortality was 4.9%. No significant differences were observed between the groups in mortality, overall morbidity or any specific complication. Comparing the SS-GSV group with the spliced vein group, no significant differences were observed between overall survival (53.2% vs. 45.7%), primary patency (55.5% vs. 53.2%), assisted primary patency (78.5% vs. 76.5%), secondary patency (87.9% vs. 90.6%) and limb salvage (83.3% vs. 82.0%).
CONCLUSIONS: The use of infrageniculate spliced vein bypasses for the treatment of CLTI patients results in similar results compared with infrageniculate SS-GSV bypass grafts. A strict surveillance protocol in the first 2 years and a liberal reintervention strategy may result in excellent long-term patency rates.


KEY WORDS: Limb salvage; Saphenous vein; Coronary artery bypass

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