Outcome Comparison Between Cryopreserved Vein and Spliced Vein As Conduit for Infrageniculate Bypass

In the absence of autogenous vein, cryopreserved greater saphenous vein is an acceptable alternative conduit for lower extremity bypass. This study compares the outcomes of cryopreserved veins (CVs), and two-segment spliced autogenous veins (SVs) for infrageniculate lower extremity revascularization. A retrospective review of all lower extremity infrageniculate bypass with CV or SV was conducted between 2010 and 2022. Primary outcomes included limb salvage and major adverse events. Secondary outcomes included primary, primary assisted, and secondary patency at 1 and 3 years. Sixty-three patients were included in the study, 48% (n = 30) with CV and 52% (n = 33) with SV. The groups did not significantly differ regarding demographics and comorbidities except that patients with prior coronary artery bypass grafting were more likely to have CV bypass (22.2% vs 3.23%; P = .042). There was no significant difference in limb loss between SV and CV at 1 (24.2% vs 33.3%; P = .443) and 3 years (18.2% vs 40.0%; P = .064). Thirty-day postoperative complications including bypass thrombosis and surgical site infection did not differ between the cohorts. Hospital readmission rates (82.2% vs 23.3%; P ≤ .001) during the first 3 years after surgery were higher in patients undergoing CV bypass. Mortality did not differ between the two cohorts at 1 and 3 years. Primary patency at 1 (57.6% vs 33.3%; P = .061) and 3 years (45.2% vs 14.3%; P = .012) was higher in the SV group. Primary assisted patency at 1 (72.7% vs 43.3%; P = .021) and 3 years (54.5% vs 26.7%; P =0 .029) was also higher in the SV group. Secondary patency was higher with SV after thrombectomy or open revision at 1 (84.8% vs 50.0%; P = .04) and 3 (63.6% vs 30.0%; P =0 .009) years. At 3 years, 85.7% of the patients were compliant with follow-up, CV (n = 24) and SV (n = 30) groups. Revascularization with a CV is an acceptable bypass alternative to an SV for patients in whom SV cannot be considered. Primary outcomes of limb salvage rates between SV and CV at 1 (75.8% vs 66.7%; P = .443) and 3 years (81.8% vs 60%; P = .064) were not statistically different. However, when comparing secondary outcomes, SV outperformed CV because patients undergoing CV had higher hospital readmission rates during the first 3 years after surgery, resulting in poor primary and secondary patency.