Prospective comparison of arm veins and greater saphenous veins as infrageniculate bypass grafts

Objectives: to compare arm and saphenous veins for infrageniculate bypass grafting. Design: prospective non-randomised study. Materials: 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% CT 0.71, 3.31) for at-in 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. Conclusion; in the setting of infrageniculate bypass grafting, arm vein crafts 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.