title: Spliced arm vein grafts are a durable conduit for lower extremity bypass.
abstract: BACKGROUND
  Many patients with peripheral vascular disease (PAD) requiring revascularization do not have adequate ipsilateral great saphenous vein (GSV) for constructing a bypass because of intrinsic vein disease or prior harvesting for limb or coronary bypass. Prosthetic conduits have poor long-term patency, especially for distal bypass. With advancing endovascular sophistication, tibial angioplasty may be a good revascularization option, but we hypothesize that using spliced arm vein for distal lower extremity bypass is still a well-tolerated and more durable solution.
  
  
  METHODS
  A retrospective chart review was conducted of all PAD patients undergoing lower extremity bypass or tibial angioplasty for lifestyle-limiting claudication or critical limb ischemia at a single institution over a 7-year period. Statistical analysis was conducted by Kaplan-Meier survival analysis and Cox proportional hazards model. Statistical significance was set at P = 0.05.
  
  
  RESULTS
  From 2005 to 2012, there were 120 patients who underwent infrageniculate revascularization with conduit other than GSV. Over half of the patients (66 patients, 71.2% male, mean age 62 years) underwent bypass operations using arm vein conduit, and 88% of those bypasses were to tibial vessels. Patency was 100% at 1 year and 85% at 2 years. There was no impact on patency or amputation rate based on the source of vein or the number of splices. Forty-three patients underwent tibial angioplasty and patency was 70% at 1 year and 50% at 2 years.
  
  
  CONCLUSIONS
  When GSV is not available, spliced arm vein grafts provide durable lower extremity revascularization with favorable patency and limb preservation rates. Spliced arm vein grafts should be considered over prosthetic grafts and angioplasty alone in patients with distal occlusive disease.
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC.
authors: Katharine L
authors: KL
authors: McGinigle
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC.
authors: Luigi
authors: L
authors: Pascarella
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC.
authors: Cynthia K
authors: CK
authors: Shortell
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC.
authors: Mitchell W
authors: MW
authors: Cox
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC.
authors: Richard L
authors: RL
authors: McCann
authors: Division of Vascular Surgery, Department of General Surgery, Duke Univeristy Medical Center, Duke University, Durham, NC. Electronic address: leila.mureebe@dm.duke.edu.
authors: Leila
authors: L
authors: Mureebe
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017130:Angioplasty / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000637:transplantation*