Women and men requiring arterial reconstruction for infrainguinal occlusive disease had comparable operative mortality and limb salvage rates, but long-term survival and graft patency were significantly reduced in women. Our results indicate that sex substantially influences the outcome of patients after infrainguinal bypass.
Although arteries appear to remodel in response to changes in hemodynamic parameters such as shear stress, little is known about functioning human vein grafts. This study was designed to explore diameter changes in human saphenous vein grafts after infrainguinal bypass. Methods: We used duplex ultrasonography to measure hemodynamic. variables that might affect the diameter of 48 in situ saphenous vein grafts during the first year after infrainguinal arterial bypass. Volumetric. flow rate, average velocity, peak systolic. velocity, and vein diameter in the proximal and distal thirds of these grafts were each measured at 1 week and at 3, 6, and 12 months after operation. Veins were divided into three groups based on initial size (1 week after bypass) in the below-knee segment: small, < 3.5 mm diameter; medium, 3.5 to 4 mm diameter; and large, >4 mm diameter. Results: Distal vein diameters at 1 week for small, medium, and large grafts were 2.9 ± 0.1, 3.7 ± 0.1,and4.3 ± 0.1 mm, respectively (p < 0.001),butby12monthsthesediameters were 3.6 ± 0.2, 3.8 ± 0.2, and 3.9 ± 0.2 mm, respectively (p = 0.54). Large veins decreased in diameter, whereas small veins increased in diameter, as confirmed by linear regression of percent change in diameter versus initial vein graft diameter (r = -0.62,
We conclude that autogenous vein pedal bypass grafts provide hemodynamic results and limb salvage rates comparable to more proximal tibial bypasses in properly selected patients.
Women and men requiring arterial reconstruction for infrainguinal occlusive disease had comparable operative mortality and limb salvage rates, but long-term survival and graft patency were significantly reduced in women. Our results indicate that sex substantially influences the outcome of patients after infrainguinal bypass.
We conclude that autogenous vein pedal bypass grafts provide hemodynamic results and limb salvage rates comparable to more proximal tibial bypasses in properly selected patients.
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