Cephalic vein grafts for lower extremity revascularization.
From 1980 to 1989 infrainguinal revascularization was performed with cephalic vein grafts in a consecutive series of 34 patients (35 limbs) whose saphenous veins were either inadequate or already had been harvested for previous coronary (N = 16, 47%) or ipsilateral lower extremity bypass (N = 19, 56%). Surgical indications included ischemic rest pain or focal tissue necrosis in 25 limbs (71%), disabling claudication in six (17%), and popliteal aneurysms or prosthetic femoropopliteal graft infections each in two (6%). Preliminary arteriovenous fistulas were constructed in the arms of 23 patients (68%) to enhance the diameter of their cephalic veins, and 24 (69%) of the 35 infrainguinal procedures in this series were performed with use of cephalic vein alone. The distal popliteal artery was used for the outflow anastomosis in 10 limbs (29%), a tibial vessel was used in 12 (34%), and the peroneal artery was used in 13 (37%). Fourteen graft occlusions (40%) and six amputations (17%) have occurred during follow-up intervals of 1 to 107 months (mean, 28 months; median, 27 months). At 3 years the cumulative primary patency rate is 40%, the secondary patency rate is 46%, and the limb salvage rate is 82%. Despite their relative inconvenience, cephalic vein grafts appear to be preferable to prosthetic materials for infrainguinal revascularization below the knee.
Sesto
M E
ME
Department of Vascular Surgery, Cleveland Clinic Foundation, OH 44195-5272.
Sullivan
T M
TM
Hertzer
N R
NR
Krajewski
L P
LP
O'Hara
P J
PJ
Beven
E G
EG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation