Improved graft patency and altered remodeling in infrainguinal vein graft reconstruction for aneurysmal versus occlusive disease

Abstract

Purpose: This study attempted to determine whether autogenous vein used for infrainguinal reconstruction in patients with aneurysmal disease might demonstrate an altered adaptive response compared with those patients who underwent reconstructive surgery for occlusive disease, potentially altering graft patency. Methods: From 1974 to 1997, 43 patients underwent vein grafting for 60 popliteal artery aneurysms (PAA). Results: In an attempt to monitor early vein graft adaptation, serial graft surveillance by Duplex ultrasound scan was performed in a statistically valid subset of age-, sex-, and distal anastomotic site–matched patients with PAA and patients with occlusive disease (OD; n = 8 PAA; n = 8 OD). Compared with an age-matched and sex-matched cohort of patients (n = 60 grafts in each group) with occlusive disease and who had femoral below-knee bypass grafts (FBP) only, patients undergoing infrainguinal reconstruction for PAA had a higher 5-year primary graft patency (92% ± 4% for PAA vs 66% ± 7% for FBP; P < .01). Duplex surveillance demonstrated a progressive increase in arterialized vein graft diameter in the PAA group versus the OD group. In univariant analysis, aneurysmal disease was a significant predictor of final follow-up diameter ( P = .002). In a linear regression model, controlling for diameter at first follow-up after bypass grafting, first follow-up diameter was also predictive of final follow-up diameter. Conclusion: These data suggested altered remodeling of vein grafts in patients with popliteal artery aneurysm, which may have a beneficial effect on patency. (J Vasc Surg 1999;29:1022-30.)