Arm veins versus contralateral greater saphenous veins for lower extremity bypass reconstruction: preliminary data of a randomized study.

BACKGROUND: The aim of this randomized study was to determine whether arm vein (AV) or contralateral greater saphenous vein (CGSV) is the better alternative vein source for lower extremity bypass reconstruction. METHODS: Consecutive patients with absent ipsilateral greater saphenous vein undergoing lower extremity revascularization were allocated to group A (AV bypass) or B (CGSV bypass). RESULTS: From 6, 2010, to 11, 2013, 64 patients (32 each group) were randomized. In all, 29 of 93 patients had to be excluded for various reasons. Median age was 76 years vs. 71 years (P = 0.01) for group A and B patients. There were no statistically significant differences regarding gender, cardiovascular risk factors, redo bypass procedures (P = 0.77), below-knee bypass procedures (P = 0.61), median bypass length (P = 0.6), and median length of incision on ipsilateral leg to perform anastomoses (P = 0.2) between group A and B patients, respectively. Incisions for vein harvest were longer in group A (P = 0.003). Overall surgical site infections (SSIs, P = 1.0) and SSI from vein harvest (P = 1.0) were equally distributed. No patient was lost to follow-up (17 vs. 18 months, P = 0.74). There was no statistically significant difference regarding primary (P = 0.77) and secondary (P = 0.25) patency rates at 1 year (group A: 52% vs. group B: 54% and group A: 72% vs. group B: 61%) and at 2 years (52% vs. 48% and 64% vs. 61%), respectively. There were 4 vs. 6 major amputations (P = 0.23) and 5 vs. 2 deaths (P = 0.1) in groups A and B during follow-up. CONCLUSIONS: Preliminary results suggest that both AV and CGSV may serve as a secondary vein bypass graft equally well.

Ultrasonic vein mapping prior to infrainguinal autogenous bypass grafting reduces postoperative infections and readmissions.

OBJECTIVE: Although duplex vein mapping (DVM) of the great saphenous vein (GSV) is common practice, there is no level I evidence for its application. Our prospective randomized trial studied the effect of preoperative DVM in infrainguinal bypass surgery. METHODS: Consecutive patients undergoing primary bypass grafting were prospectively randomized for DVM of the GSV (group A) or no DMV of the GSV (group B) before surgery. Society for Vascular Surgery reporting standards were applied. RESULTS: From December 2009 to December 2010, 103 patients were enrolled: 51 (group A) underwent DVM of the GSV, and 52 (group B) did not. Group A and group B not differ statistically in age (72.8 vs 71.1 years), sex (women, 29.4% vs 34.6%), cardiovascular risk factors, body mass index (25.9 vs 26.1 kg/m(2)), bypass anatomy, and runoff. Group A and B had equal operative time (151.4 vs 151.1 minutes), incisional length (39.4 vs 39.9 cm), and secondary bypass patency at 30 days (96.1% vs 96.2%; P = .49). Conduit issues resulted in six intraoperative changes of the operative plan in group B vs none in group A (P = .014). Median postoperative length of stay was comparable in both groups (P = .18). Surgical site infections (SSIs) were classified (in group A vs B) as minor (23.5% vs 23.1%; P = 1.0) and major (1.9% vs 21.2%; P = .004). Readmissions due to SSIs were 3.9% in group A vs 19.2% in group B (P = .028). Two patients in group B died after complications of SSIs. Multivariate analysis identified preoperative DVM as the only significant factor influencing the development of major SSI (P = .0038). CONCLUSIONS: Routine DVM should be recommended for infrainguinal bypass surgery. The study found that preoperative DVM significantly avoids unnecessary surgical exploration, development of major SSI, and reduces frequency of readmissions for SSI treatment.