Alternative Autologous Vein Grafts versus Single-Segment Great Saphenous Vein in Lower Extremity Bypass Surgery-Single-Center Study.

Background: Studies comparing alternative autologous vein grafts (AAVGs) to single-segment great saphenous vein (ssGSV) grafts report mixed results. The status of AAVG as first choice when ssGSV is unavailable is not unequivocal based on current evidence. Our study compares results between AAVG and ssGSV in lower extremity bypass (LEB) surgery.

Methods: A single-center retrospective cohort study involving all patients who underwent infrainguinal bypass using AAVG (arm veins, spliced arm, or arm-leg veins) and ssGSV from April 2019 to June 2023. Study endpoints were patency rates and amputation-free survival (AFS).

Results: There were 65 (20.8%) patients in the AAVG group, 247 (79.2%) in the ssGSV group. Chronic limb-threatening ischemia (CLTI) was the most frequent indication for surgery (AAVG 54/65, 83.1% vs. ssGSV 170/247, 68.8%), followed by acute limb ischemia (ALI) (AAVG 6/65, 9.2% vs. ssGSV 28/247, 11.3%); claudicants were presented only in the ssGSV group (AAVG 0/65, 0% vs. ssGSV 44/247, 17.8%). More redo operations occurred in AAVG than in the ssGSV group (23/65, 35.4% vs. 26/247, 10.5%; P < 0.001). Spliced vein grafts represented 87.7% (57/65) of AAVG bypasses. The median follow-up was 20.1 months for the AAVG group and 27.5 for the ssGSV group. Three-year patency rates between AAVG versus ssGSV: primary patency (PP) 59.3% ± 8.2% versus 69.2% ± 3.8%, P = 0.113; primary assisted patency (PAP) 75.2% ± 7.1% versus 73.5% ± 3.4%, P = 0.790; secondary patency (SP) 74.9% ± 7.1% versus 74.4% ± 3.4%, P = 0.667; did not display significant difference between groups nor did 3-year AFS in CLTI patients; 70.7% ± 7.9% versus 54.6% ± 4.8%; P = 0.273.

Conclusion: AAVGs should be the first conduit choice when ssGSV is unavailable. Mid-term patency rates do not differ from those of ssGSV grafts despite higher reintervention rate.