Prospective comparison of arm veins and greater saphenous veins as infrageniculate bypass grafts.
OBJECTIVE
to compare arm and saphenous veins for infrageniculate bypass grafting.


METHODS
prospective non-randomised study.


METHODS
two hundred patients, of which 197 had ischaemic tissue loss or rest pain.


METHODS
two hundred and eleven infrageniculate vein bypass procedures using 176 greater saphenous veins and 35 arm veins.


RESULTS
the cumulative primary graft patency rate at 1-month and 2 years was 80% and 61% for saphenous vein and 89% and 42% for arm vein. The corresponding rates for secondary patency were 84.5% and 68%, and 91% and 57%, respectively. These results corresponded to a relative risk of secondary failure of 1.53 (95% CI 0.71, 3.31) for arm vein grafts. In subgroup analyses, this estimate was 0.93 and 2.1 for primary vs secondary bypasses and 0.38 and 2.06 for single-vein vs spliced-vein bypasses. Among arm veins, cephalic vein grafts performed better than basilic vein grafts. Early mortality was 14% for arm vein and 10% for saphenous vein.


CONCLUSIONS
in the setting of infrageniculate bypass grafting, arm vein grafts are not equivalent to greater saphenous vein grafts, but contribute importantly to a policy of using autologous veins. The possibility of equivalence remains for the arm vein graft that uses a cephalic vein or is a primary procedure.
Brochado-Neto
F C
FC
Serviço de Cirurgia Vascular, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, Brasil.
Albers
M
M
Pereira
C A
CA
Gonzalez
J
J
Cinelli
M
M
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007383:Intermittent Claudication / Q000401:mortality / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D015996:Survival Rate; D014182:Transplantation, Autologous; D014680:Veins / Q000637:transplantation*