Use of Suboptimal Great Saphenous Vein in Lower Extremity Bypass Yields Favorable Amputation-Free Survival.

Abstract

Objective: Historically, studies have identified a great saphenous vein (GSV) diameter of at least 3.0 mm for optimal durability following lower extremity bypass. With the recent publication of BEST-CLI and BASIL-2 studies, we sought to compare patency and post-operative complications utilizing GSV conduit of <3.0 mm to veins ≥3.0 mm or alternative conduits from a single institution.

Methods: Patients with pre-operative GSV vein mapping in an Intersocietal Accreditation Commission accredited vascular lab who underwent infra-inguinal bypass surgery at a tertiary center were included. Vascular lab software was utilized to compare patient median GSV across at least six anatomic locations. Patients were seperated and stratified based on median GSV size (both overall and limited to above or below-knee GSV). Primary outcomes included post-operative complications, 30-day major adverse limb events (MALE), major adverse cardiac events (MACE), and patency at regular follow-up intervals.

Results: From January 2016 to February 2022, 178 patients underwent bypass with pre-operative vein mapping: 82 who received GSV<3.0 mm and 96 who received GSV≥3.0 mm. Patients were evenly distributed in demographics including proximal and distal targets. Median follow-up was 1.90 years. Overall, use of <3.0 mm GSV was not associated with inferior one-year primary patency compared to ≥3.0 GSV (82.1 vs 89.4%), however, there was a significant increase in post-operative creatinine unique to patients with GSV<3.0mm alone (8.5% vs 1.1%, p=0.026). There were no differences in 30-day MACE or MALE between groups. In surveillance up to three years, patients who received GSV≥3.0 mm versus GSV<3.0mm conduits had similar reintervention and amputation-free survival rates (p=0.999).

Conclusions: Patients who received GSV bypasses <3.0 mm have the same mid-term patency, reintervention rates, and amputation-free survival as patients who received GSV≥3.0 mm. Use of smaller GSVs may require closer follow-up for acute kidney injury. Nonetheless, under appropriate circumstances, sub-optimal GSV can be utilized for lower extremity arterial bypass.