Use of arm veins for lower extremity arterial bypass--results, anatomical features and technical considerations.
Forty lower limb bypasses using arm veins were performed on 37 patients. The indications for surgery were limb threat in 50% of cases, graft failure in 33%, aneurysms in 10% and claudication in 7%. Saphenous veins were absent because of prior use in 73% of cases, and because they were unsuitable in 27%. A single vein was used in 48%, 2 veins in 40% and 3 veins in 12% of cases. Seventy-four per cent of cases had a single-vessel run-off below the distal anastomosis. Eighty-two per cent of the distal anastomoses were to infrapopliteal arteries. The primary and secondary rates of these 40 bypasses at a mean follow-up of 14 months (range 1-40 months) were 74% and 90%, respectively. Limb salvage was 94%. Peri-operative morbidity and mortality were 23% and 3%, respectively. The anatomical and technical aspects of harvesting arm veins are critical to the success of this procedure and will be emphasised. We have found arm veins to be a durable source of accessible autogenous grafts for lower limb revascularisation in the absence of suitable saphenous veins.
Browning
N
N
Providence Medical Center, Seattle, Washington, USA.
Zammit
M
M
Rodriguez
D
D
Sauvage
L
L
Loudenback
D
D
Raghavan
A
A
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000783:Aneurysm / Q000601:surgery; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000601:surgery; D003097:Collateral Circulation / Q000502:physiology; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply; D006085:Graft Survival; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D011183:Postoperative Complications; D012501:Saphenous Vein; D015996:Survival Rate; D016909:Tibial Arteries / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation*