PMID- 31603296 OWN - NLM STAT- MEDLINE DCOM- 20200120 LR - 20200120 IS - 1827-191X (Electronic) IS - 0021-9509 (Linking) VI - 60 IP - 6 DP - 2019 Dec TI - The role of infragenicular spliced vein bypass surgery in patients with chronic limb-threatening ischemia: single center long-term results. PG - 686-692 LID - 10.23736/S0021-9509.19.11110-X [doi] AB - BACKGROUND: In patients requiring infrageniculate surgical revascularization a single-segment great saphenous vein (SS-GSV) is the optimal conduit. In the absence of a SS-GSV, the small saphenous vein and arm veins can also be used to obtain an all-autologous bypass. The aim of this study was to compare the long-term results of infrageniculate SS-GSV bypasses and spliced vein bypasses in patients with chronic limb-threatening ischemia (CLTI). METHODS: A total of 308 consecutive CLTI patients who underwent a primary infragenicular, autologous bypass between January 2000 and December 2016 were included. The definition of a spliced vein bypass was a graft consisting of at least two venous segments. RESULTS: A SS-GSV graft was used in 235 patients, and a spliced vein graft was used in 73 patients. Significantly more infrapopliteal bypasses were performed in the spliced vein group (P=0.024), and in this group the mean operation time was almost 60 minutes longer (P<0.001). The overall morbidity rate was 44%. The overall 30-day mortality was 3.2%, and overall in-hospital mortality was 4.9%. No significant differences were observed between the groups in mortality, overall morbidity or any specific complication. Comparing the SS-GSV group with the spliced vein group, no significant differences were observed between overall survival (53.2% vs. 45.7%), primary patency (55.5% vs. 53.2%), assisted primary patency (78.5% vs. 76.5%), secondary patency (87.9% vs. 90.6%) and limb salvage (83.3% vs. 82.0%). CONCLUSIONS: The use of infrageniculate spliced vein bypasses for the treatment of CLTI patients results in similar results compared with infrageniculate SS-GSV bypass grafts. A strict surveillance protocol in the first 2 years and a liberal reintervention strategy may result in excellent long-term patency rates. FAU - van Mierlo, Patricia A AU - van Mierlo PA AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - Bekkers, Wouter J AU - Bekkers WJ AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - van 't Land, Freek R AU - van 't Land FR AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - van Mierlo, Arjen G AU - van Mierlo AG AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - de Smet, Andre A AU - de Smet AA AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands. FAU - Fioole, Bram AU - Fioole B AD - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands - fiooleb@maasstadziekenhuis.nl. LA - eng PT - Comparative Study PT - Journal Article DEP - 20191009 PL - Italy TA - J Cardiovasc Surg (Torino) JT - The Journal of cardiovascular surgery JID - 0066127 SB - IM MH - Aged MH - Aged, 80 and over MH - Chronic Disease MH - Female MH - Hospital Mortality MH - Humans MH - Ischemia/diagnostic imaging/mortality/physiopathology/*surgery MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Netherlands MH - Peripheral Arterial Disease/diagnostic imaging/mortality/physiopathology/*surgery MH - Regional Blood Flow MH - Retrospective Studies MH - Saphenous Vein/*transplantation MH - Time Factors MH - Treatment Outcome MH - Vascular Grafting/adverse effects/*methods/mortality MH - Vascular Patency EDAT- 2019/10/12 06:00 MHDA- 2020/01/21 06:00 CRDT- 2019/10/12 06:00 PHST- 2019/10/12 06:00 [pubmed] PHST- 2020/01/21 06:00 [medline] PHST- 2019/10/12 06:00 [entrez] AID - S0021-9509.19.11110-X [pii] AID - 10.23736/S0021-9509.19.11110-X [doi] PST - ppublish SO - J Cardiovasc Surg (Torino). 2019 Dec;60(6):686-692. doi: 10.23736/S0021-9509.19.11110-X. Epub 2019 Oct 9.