Impact of Limb Severity on the Wall Structure of the Great Saphenous Vein and Its Involvement in Vein Graft Patency

Abstract

Objectives: This study aimed to determine pathologically how limb severity in chronic limb-threatening ischemia affects the great saphenous vein (GSV) wall, and whether it influences vein graft patency.

Methods: In 89 limbs undergoing infrainguinal bypass with the ipsilateral GSV, the intimal and medial thickness of the residual vein segment was measured. Wound (W), ischemia (I), and foot infection (fI) grades were assessed, with loss of primary graft patency as the endpoint.

Results: Primary patency was 72.3% at 1 year and 59.3% at 2 years. Independent factors for patency loss were poor-quality vein (hazard ratio [HR] 3.12), severe W grade (HR 2.63), and cerebrovascular disease. Severe W cases had a thicker intima (56.0 vs. 28.1 μm, P <0.01) and media (310.4 vs. 255.8 μm, P = 0.02) than mild cases; the I and fI grades showed no differences. Between the patency-loss (n = 31) and maintained (n = 58) groups, intimal thickness was similar (51.2 vs. 44.1 μm, P = 0.57), whereas medial thickness differed (349.9 vs. 261.1 μm, P <0.01; area under the curve 0.65). Above versus below a 280-μm medial cutoff, patency was 43.0% versus 75.7% (P = 0.03).

Conclusions: Medial thickening of the preplacement GSV, seen with a severe wound grade, may be a critical factor in vein graft failure. (This is a secondary publication of Jpn J Phlebol 2025; 36: 89–97.)