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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1996 Nov;78(6):497–500.

Arm vein reconstruction for limb salvage: long-term outcome.

P V Tisi 1, A J Crow 1, C P Shearman 1
PMCID: PMC2502868  PMID: 8943631

Abstract

A series of 42 consecutive patients undergoing infrainguinal vascular reconstruction for limb salvage using vein harvested from the arm were followed prospectively to determine the long-term graft patency and stenosis rates. Vein harvested from the arm ('arm vein') was used for secondary or tertiary reconstruction in 22 patients (52.4%). The outflow was to a single calf vessel in 37 grafts (88.1%). The cumulative primary, primary assisted and secondary graft patency rates were 35.6%, 49.6% and 59.5% at 2 years, respectively, and the limb salvage rate was 69.0% at 2 years. Eight grafts developed stenoses detected by a graft surveillance programme. Six stenoses were dilated successfully with percutaneous transluminal angioplasty (PTA) and one was treated with an interposition vein graft. Bypass using arm vein is time-consuming and technically demanding as multiple anastomoses are often required. Arm vein grafts, however, have no greater incidence of stenosis than long saphenous vein grafts and these stenoses may be dilated with PTA with good results. The long-term outcome suggests that an arm vein graft is an important treatment option in the absence of the long saphenous vein.

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Selected References

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  1. Andros G., Harris R. W., Salles-Cunha S. X., Dulawa L. B., Oblath R. W., Apyan R. L. Arm veins for arterial revascularization of the leg: arteriographic and clinical observations. J Vasc Surg. 1986 Nov;4(5):416–427. [PubMed] [Google Scholar]
  2. Bergan J. J., Veith F. J., Bernhard V. M., Yao J. S., Flinn W. R., Gupta S. K., Scher L. A., Samson R. H., Towne J. B. Randomization of autogenous vein and polytetrafluorethylene grafts in femoral-distal reconstruction. Surgery. 1982 Dec;92(6):921–930. [PubMed] [Google Scholar]
  3. Budd J. S., Brennan J., Beard J. D., Warren H., Burton P. R., Bell P. R. Infrainguinal bypass surgery: factors determining late graft patency. Br J Surg. 1990 Dec;77(12):1382–1387. doi: 10.1002/bjs.1800771220. [DOI] [PubMed] [Google Scholar]
  4. Chalmers R. T., Hoballah J. J., Kresowik T. F., Sharp W. J., Synn A. Y., Miller E., Corson J. D. The impact of color duplex surveillance on the outcome of lower limb bypass with segments of arm veins. J Vasc Surg. 1994 Feb;19(2):279–288. doi: 10.1016/s0741-5214(94)70103-2. [DOI] [PubMed] [Google Scholar]
  5. Cheshire N. J., Noone M. A., Wolfe J. H. Re-intervention after vascular surgery for critical leg ischaemia. Eur J Vasc Surg. 1992 Sep;6(5):545–550. doi: 10.1016/s0950-821x(05)80631-0. [DOI] [PubMed] [Google Scholar]
  6. Dunlop P., Varty K., Hartshorne T., Bell P. R., Bolia A., London N. J. Percutaneous transluminal angioplasty of infrainguinal vein graft stenosis: long-term outcome. Br J Surg. 1995 Feb;82(2):204–206. doi: 10.1002/bjs.1800820220. [DOI] [PubMed] [Google Scholar]
  7. Grigg M. J., Wolfe J. H. Combination reversed and non-reversed upper arm vein for femoro-distal grafting. Eur J Vasc Surg. 1988 Feb;2(1):49–52. doi: 10.1016/s0950-821x(88)80108-7. [DOI] [PubMed] [Google Scholar]
  8. Harward T. R., Coe D., Flynn T. C., Seeger J. M. The use of arm vein conduits during infrageniculate arterial bypass. J Vasc Surg. 1992 Sep;16(3):420–427. [PubMed] [Google Scholar]
  9. Hickey N. C., Thomson I. A., Shearman C. P., Simms M. H. Aggressive arterial reconstruction for critical lower limb ischaemia. Br J Surg. 1991 Dec;78(12):1476–1478. doi: 10.1002/bjs.1800781222. [DOI] [PubMed] [Google Scholar]
  10. Hölzenbein T. J., Pomposelli F. B., Jr, Miller A., Gibbons G. W., Campbell D. R., Freeman D. V., LoGerfo F. W. The upper arm basilic-cephalic loop for distal bypass grafting: technical considerations and follow-up. J Vasc Surg. 1995 Apr;21(4):586–594. doi: 10.1016/s0741-5214(95)70190-7. [DOI] [PubMed] [Google Scholar]
  11. Londrey G. L., Bosher L. P., Brown P. W., Stoneburner F. D., Jr, Pancoast J. W., Davis R. K. Infrainguinal reconstruction with arm vein, lesser saphenous vein, and remnants of greater saphenous vein: a report of 257 cases. J Vasc Surg. 1994 Sep;20(3):451–457. doi: 10.1016/0741-5214(94)90145-7. [DOI] [PubMed] [Google Scholar]
  12. Marcaccio E. J., Miller A., Tannenbaum G. A., Lavin P. T., Gibbons G. W., Pomposelli F. B., Jr, Freeman D. V., Campbell D. R., LoGerfo F. W. Angioscopically directed interventions improve arm vein bypass grafts. J Vasc Surg. 1993 Jun;17(6):994–1004. doi: 10.1067/mva.1993.46530. [DOI] [PubMed] [Google Scholar]
  13. Shearman C. P., Gwynn B. R., Curran F., Gannon M. X., Simms M. H. Non-invasive femoropopliteal assessment: is that angiogram really necessary? Br Med J (Clin Res Ed) 1986 Oct 25;293(6554):1086–1089. doi: 10.1136/bmj.293.6554.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Sladen J. G., Reid J. D., Riggs M. O. Harvest of brachio-basilic vein complex for arterial bypass. J Cardiovasc Surg (Torino) 1992 Mar-Apr;33(2):169–171. [PubMed] [Google Scholar]
  15. Stonebridge P. A., Miller A., Tsoukas A., Brophy C. M., Gibbons G. W., Freeman D. V., Pomposelli F. B., Jr, Campbell D. R., LoGerfo F. W. Angioscopy of arm vein infrainguinal bypass grafts. Ann Vasc Surg. 1991 Mar;5(2):170–175. doi: 10.1007/BF02016751. [DOI] [PubMed] [Google Scholar]
  16. Taylor P. R., Wolfe J. H., Tyrrell M. R., Mansfield A. O., Nicolaides A. N., Houston R. E. Graft stenosis: justification for 1-year surveillance. Br J Surg. 1990 Oct;77(10):1125–1128. doi: 10.1002/bjs.1800771016. [DOI] [PubMed] [Google Scholar]
  17. Tyrrell M. R., Grigg M. J., Wolfe J. H. Is arterial reconstruction to the ankle worthwhile in the absence of autologous vein? Eur J Vasc Surg. 1989 Oct;3(5):429–434. doi: 10.1016/s0950-821x(89)80051-9. [DOI] [PubMed] [Google Scholar]
  18. Wolfe J. H., Tyrrell M. R. Justifying arterial reconstruction to crural vessels--even with a prosthetic graft. Br J Surg. 1991 Aug;78(8):897–899. doi: 10.1002/bjs.1800780802. [DOI] [PubMed] [Google Scholar]

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