Infrainguinal Bypass for Peripheral Arterial Occlusive Disease: When Arms Save Legs

Objectives: Determine if arm veins are good conduits for infrainguinal revascularisation and should be used when good quality saphenous vein is not available. Design: Retrospective study. Materials and methods: We evaluated a consecutive series of infrainguinal bypass (IB) using arm vein conduits fromMarch 2001 to December 2006.We selected arm vein by preoperative ultrasound mapping to identify suitable veins. We measured vein diameter and assessed vein wall quality. We followed patients with systematic duplex imaging at 1 week, 1, 3, 6 and 12 months, and annually thereafter. We treated significative stenoses found during the follow-up. Results: We performed 56 infrainguinal revascularisation using arm vein conduits in 56 patients. Primary patency rates at 1, 2 and 3 years were 65%, 51% and 47%. Primary assisted patencies at 1, 2 and 3 years were 96%, 96% and 82%. Secondary patency rates at 1, 2 and 3 years were 92%, 88% and 88%. The threeyear limb salvage rate was 88%. Conclusions: We conclude that infrainguinal bypass using arm vein for conduits gives good patency rates, if selected by a preoperative US mapping to use the best autogenous conduit available. 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. With the improvement in the quality of life and medical therapies, there is an increase in both life expectancy and the patient’s expectations. Medicine has to cope with older patients and their growing lists of comorbidities,1 thereby complicating the framework conditions for vascular surgery. In fact, the ageing patient is apt to benefit from a bypass (be it cardiac or leg), and surgical options are now considered even for elderly patients. Nevertheless, the fundamental problem of a limited number of great saphenous veins (GSVs) available per patient still remains. Bioengineering has already tried to solve this lack of conduit, but without success.2 Veins are still considered superior to prostheses in terms of long-term patency,3e14 and the GSV remains the conduit of choice.6e12 However, other surgeons or pathologies may have laid claim first to this valued vein. tions on this paper, please go