PMID- 37343730 OWN - NLM STAT- MEDLINE DCOM- 20230925 LR - 20230927 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 78 IP - 4 DP - 2023 Oct TI - Efficacy and safety of iliofemoral bypass using arm veins as an alternative conduit for chronic limb-threatening ischemia. PG - 1021-1029.e3 LID - S0741-5214(23)01316-2 [pii] LID - 10.1016/j.jvs.2023.06.009 [doi] AB - OBJECTIVE: The use of basilic vein in iliofemoral revascularizations was previously described in the literature as an autologous option for the treatment of vascular prosthesis infection and as a primary conduit in patients at high risk of infectious surgical complications. However, the publications available include several different indications and are limited to case reports. Therefore, the aim of this study was to evaluate the outcomes of the use of arm veins as a safe and effective autologous alternative for iliofemoral reconstruction in patients with chronic limb-threatening ischemia (CLTI) and at high risk of prosthesis infection. METHODS: We performed a multicenter, retrospective cohort study with 53 consecutive iliofemoral bypasses using arm veins as an alternative conduit. The procedures were performed between November 2013 and November 2021, exclusively for patients with CLTI classified as TASC aortoiliac C or D with increased risk of postoperative surgical infection. Demographic, clinical variables, and outcomes were collected from a prospective database. Main endpoints were amputation-free survival (AFS) and major adverse cardiovascular events. Secondary endpoints included primary and secondary patencies and overall survival. Cox regression analysis was used to identify the predictors of AFS. Postoperative surgical complications and 30-day mortality were also assessed. RESULTS: The mean age was 64.2 +/- 8.4 years, with a predominance of male gender. The median follow-up period was 615 days. All patients had CLTI, with a predominance of tissue loss (n = 51; 96.2%) and a median ankle-brachial index of 0.28. The basilic vein was utilized in most procedures (69.8%). Thirty-day major adverse cardiovascular events occurred in five cases (9.4%), and the 30-day mortality rate was 3.8%. The AFS, primary patency, secondary patency, and overall survival in 720 days were 71%, 72%, 89%, and 75%, respectively. Cox regression analysis revealed no association between the variables analyzed for AFS. There was no graft late infection nor pseudoaneurysmal degeneration. CONCLUSIONS: Iliofemoral bypass using arm veins as an autologous conduit proved to be an effective and safe procedure with low incidence of postoperative cardiovascular complications and high rates of AFS in patients with CLTI. Also, this suggests that arm veins can be an interesting and suitable autologous alternative conduit for iliofemoral reconstructions, especially in cases in which a prosthesis should be avoided or when it is not available. CI - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Giusti, Julio Cesar Gomes AU - Giusti JCG AD - Department of Vascular and Endovascular Surgery, Hospital Municipal Dr. Carmino Caricchio - HMCC, Sao Paulo, Sao Paulo, Brazil. Electronic address: julio@ccvp.med.br. FAU - Rossi, Fabio Henrique AU - Rossi FH AD - Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia - IDPC, Sao Paulo, Sao Paulo, Brazil. FAU - Cury, Marcus Vinicius Martins AU - Cury MVM AD - Department of Vascular and Endovascular Surgery, Hospital do Servidor Publico Estadual - HSPE, Sao Paulo, Sao Paulo, Brazil. FAU - Godoy, Marcos Roberto AU - Godoy MR AD - Department of Vascular and Endovascular Surgery, Hospital do Servidor Publico Estadual - HSPE, Sao Paulo, Sao Paulo, Brazil. FAU - Palomo, Amanda Thurler AU - Palomo AT AD - Department of Vascular and Endovascular Surgery, Hospital do Servidor Publico Estadual - HSPE, Sao Paulo, Sao Paulo, Brazil. FAU - Sacilotto, Roberto AU - Sacilotto R AD - Department of Vascular and Endovascular Surgery, Hospital do Servidor Publico Estadual - HSPE, Sao Paulo, Sao Paulo, Brazil. FAU - Brochado Neto, Francisco Cardoso AU - Brochado Neto FC AD - Department of Vascular and Endovascular Surgery, Hospital Municipal Dr. Carmino Caricchio - HMCC, Sao Paulo, Sao Paulo, Brazil; Department of Vascular and Endovascular Surgery, Hospital do Servidor Publico Estadual - HSPE, Sao Paulo, Sao Paulo, Brazil. FAU - Izukawa, Nilo Mitsuru AU - Izukawa NM AD - Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia - IDPC, Sao Paulo, Sao Paulo, Brazil. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20230619 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Humans MH - Male MH - Middle Aged MH - Aged MH - Female MH - *Chronic Limb-Threatening Ischemia MH - *Arm MH - Retrospective Studies MH - Lower Extremity/blood supply MH - Treatment Outcome MH - Limb Salvage/methods MH - Risk Factors MH - Ischemia/diagnostic imaging/surgery MH - Blood Vessel Prosthesis/adverse effects MH - Postoperative Complications/etiology MH - Vascular Patency OTO - NOTNLM OT - Amputation-free survival OT - Chronic limb-threatening ischemia OT - Iliofemoral bypass OT - Limb salvage OT - Vascular graft EDAT- 2023/06/22 01:07 MHDA- 2023/09/25 06:42 CRDT- 2023/06/21 19:15 PHST- 2023/05/06 00:00 [received] PHST- 2023/06/08 00:00 [revised] PHST- 2023/06/11 00:00 [accepted] PHST- 2023/09/25 06:42 [medline] PHST- 2023/06/22 01:07 [pubmed] PHST- 2023/06/21 19:15 [entrez] AID - S0741-5214(23)01316-2 [pii] AID - 10.1016/j.jvs.2023.06.009 [doi] PST - ppublish SO - J Vasc Surg. 2023 Oct;78(4):1021-1029.e3. doi: 10.1016/j.jvs.2023.06.009. Epub 2023 Jun 19.