As part of our ongoing commitment to collaborative learning and improved patient outcomes, we would like to make you aware of a recent study published in the Journal of Vascular Surgery entitled, “Autologous alternative veins may not provide better outcomes than prosthetic conduits for below-knee bypass when great saphenous vein is unavailable” (J Vasc Surg. 2015;62(2):385-391.).
In this study, Avgerinos et al retrospectively reviewed graft patency and limb salvage rates up to five years in 407 consecutive infrainguinal bypasses to below-knee targets. The study included 255 patients (63%) receiving a single-segment greater saphenous vein (GSV), 106 patients (26%) receiving an alternative autologous vein (AAV), and 46 patients (11%) receiving a prosthetic conduit, 41 (89%) of which were GORE® PROPATEN® Vascular Grafts. The results showed a primary patency at two and five years estimated at 47% and 32%, respectively, for the GSV group; 24% and 23% for the AAV group; and 43% and 38% for the prosthetic group. Limb salvage was similar among groups. Statistical analysis showed that primary patency, primary assisted patency, and secondary patency were predicted by GSV compared with AAV, but there was no difference between AAV and prosthetic grafts except for the primary patency, for which prosthetic was protective.
“ Of note, most prosthetic grafts used in our study were heparin-bonded PTFE grafts, and this may partly explain their similar if not better performance compared with AAV at midterm follow-up... When GSV is not available, AAV conduits may not offer any significant advantage over prosthetic bypass for below-knee targets at midterm follow-up. The results of this study should guide our current practice toward more thoughtful selection of candidates for AAV.” (J Vasc Surg. 2015;62(2):385-391.)
To find out more, visit to: photo of Avgerinos, MD
Alternative conduits: Are arm vein, spliced vein, sequential grafts effective?
Efthymios D. Avgerinos, MD
View abstract or order article reprint of the Journal of Vascular Surgery article discussed above
Watch the presentation video or download a written summary of Avgerinos, MD discussing his data at the Surgical Bypass Summit
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