The impact of alternative autologous venous material on limb salvage rates in patients with chronic limb-threatening ischemia

BACKGROUND: Chronic limb-threatening ischemia (CLTI) represents the advanced stage of peripheral artery disease, causing chronic ischemic pain, ulcers or gangrene. Choosing between endovascular and open surgical revascularization for CLTI is crucial, with challenges like graft restenosis. Autologous venous material, in particular the great saphenous vein (GSV), shows superior outcomes. The study compares outcomes of CLTI surgical revascularization using GSV versus alternative autologous venous grafts, enhancing treatment decisions and predicting risk of complications and amputation limb. METHODS: The analysis involved 298 CLTI patients treated with autologous vein bypass revascularization. Preoperative, intraoperative and postoperative data were examined, with outcomes encompassing perioperative morbidity, mortality, graft occlusion, amputations and reinterventions. RESULTS: The study analyzed 298 CLTI patients with GSV or alternative autologous venous graft bypasses. GSV demonstrated lower 30-day (4.7% vs. 13%) and long-term occlusion rates (17.8% vs. 30.4%). GSV emerged as a protective factor for occlusion, both short and long term. Previous endovascular interventions negatively affected short-term GSV patency. Although no significant differences in reintervention rates were observed, there was a higher risk with alternative venous conduits (30.4%) compared to GSV (21.0%) in the follow-up. Kaplan-Meier analysis showed higher limb salvage rates for GSV (88% at 2 years) than alternatives (78% at 2 years). CONCLUSIONS: Surgical bypass with the GSV yields optimal CLTI patient outcomes. Alternative autologous venous material provides satisfactory results but requires longer surgical times and advanced skills. The study suggests surgical bypass, particularly with the GSV, should be the primary revascularization strategy for CLTI patients.