Results of bypass to the popliteal and tibial arteries with alternative sources of autogenous vein

Purpose: The goal of an all-autogenous policy for infrainguinal arterial bypass requires that many bypasses be performed with alternative autogenous veins (AAV) because an adequate length of ipsilateral or contralateral greater saphenous vein (GSV) is not available. The durability and efficacy of infrainguinal vein bypasses constructed of venous conduits other than a single segment of greater saphenous vein (SSGSV) is, however, questioned. Methods: AAV and GSV bypasses were reviewed from 1980 through 1994. Patients who required bypass to the popliteal or a tibial artery were compared for vascular surgical history and vascular disease risk factors and life-table survival. AAV and SSGSV procedures were compared for indications for surgery, morbidity and mortality rates, limb salvage rates in patients who underwent surgery for limb-salvage indications, subsequent need for revision, and life- table-assisted primary patency. Results: Nine hundred nineteen autogenous vein bypasses were performed to the popliteal or a tibial artery - 187 (20%) with AAVs, including whole or partial arm vein conduits in 144 grafts (77%). One hundred fourteen AAVs (61%) required vein splicing. The mortality rate was 2% for SSGSV bypasses and 1% for AAV bypasses. The morbidity rate was higher for GSV surgery as a result of increased wound complications (11% vs 5%; p = 0.02). Sixty-seven percent of patients with AAV bypass extremities had undergone previous ipsilateral arterial surgery, compared with 20% of patient with SSGSV bypasses (p = 0.0005). AAV bypasses were more likely to be to a tibial artery (71% vs 45%; p < 0.0001). Twelve percent of SSGSV and 15% of AAV popliteal bypasses required revision (p = NS). The 5-year assisted primary patencies were 82%, 77%, and 63%, with limb salvage rates of 91%, 86%, and 74% for ipsilateral SSGSV, contralateral SSGSV, and AAV femoropopliteal bypasses, respectively. Twelve percent of SSGSV and 30% of AAV tibial bypasses required revision (p = 0.0001). The 5-year assisted primary patencies were 74%, 82%, and 72%, with limb salvage rates of 84%, 92%, and 78% for ipsilateral SSGSV, contralateral SSGSV, and AAV femorotibial bypasses, respectively. Conclusion: AAV bypasses can provide overall results comparable with SSGSV bypasses.