Non-reversed Bifurcated Vein Graft Improves Time of Healing in Ischemic Patients Undergoing Lower Limb Distal Bypass

Objective: The aim was to retrospectively compare non-reversed bifurcated versus single vein graft in patients with critical limb-threatening ischemia (CLTI) undergoing lower limb distal bypass. Methods: Between January 2015 and December 2021, 193 patients with lower limb ischemic lesions have been treated at our Center with vein bypass and distal anastomosis performed on one or more tibial/foot vessels. One-hundred-thirty-seven patients (71%) received a single graft (Group SIN), and 56 patients (29%) had a bifurcated bypass (Group BIF). Primary outcome measures were time of healing, primary patency, primary assisted patency, secondary patency, and limb salvage. Two-year outcomes according to Kaplan-Meier curves were evaluated and compared. Results: Both groups were homogeneous in terms of demographic data, preoperative risk factors, and clinical presentation but for an elderly age in Group BIF (77.5 vs. 71.5 years; p <0.001). Intraoperative technical success was achieved in all patients. Overall median duration of follow-up was 19 months (interquartile range 9–36). Wound healing did not differ between the two groups (77.4% Group SIN vs. 73.2% Group BIF; p = 0.33). Mean time to healing was faster in Group BIF (2.4 vs. 6.8 months; p <0.001). At 2-year follow-up there were no differences between the two groups in terms of primary patency (71.4% Group SIN vs. 54% Group BIF; p = 0.10), primary assisted patency (81.7% Group SIN vs. 76.4% Group BIF; p = 0.53), secondary patency (85.1% Group SIN vs. 80.9% Group BIF; p = 0.79), and limb salvage (92.3% Group SIN vs. 87.2% Group BIF; p = 0.64) ([Fig.]). Conclusion: Bifurcated graft improved time to healing in CLTI patients undergoing infrapopliteal non-reversed vein bypass. Two-year overall patencies and limb salvage did not differ according to vein graft configuration (single vs. bifurcated).