Nonreversed great saphenous vein grafts for vascular reconstruction after resection of lower-limb sarcoma

Abstract

ObjectiveReversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and the cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow non-reversed GSV graft. The purpose of this study was to evaluate the safety and versatility of this technique. DesignWe retrospectively compared long-term patency and limb salvage rates between non-reversed GSV and reversed GSV in patients undergoing limb-sparing surgery for sarcoma. MethodsThirty-seven patients were included, with 21 in the non-reversed GSV group and 16 in the reversed GSV group. Patient characteristics, surgical details, and complications were reviewed from the hospital records. The patency of reconstructed vessels was assessed by contrast-enhanced CT or MRI. Statistical analyses, including Kaplan–Meier survival analysis, were employed for comparisons. ResultsThe median follow-up was 38 months. Overall graft patency was 90.4% (19 of 21 patients) in the non-reversed GSV group and 81.2% (13 of 16) in the reversed RGSV group. In the non-reversed GSV group, there was one case of graft occlusion each in the acute phase and chronic phase, but limb circulation remained intact and all limbs were spared. ConclusionNon-reversed GSV grafting with a valvulotome offers a safe and versatile alternative to reversed GSV grafts in limb-sparing sarcoma surgery. It eliminates the need for vein reversal and minimizes diameter mismatch, potentially expanding the indication for autologous revascularization in previously ineligible cases.