41. Long Term Follow-up of Saphenous Vein Interposition Grafts in Severely Calcified Patients Undergoing Lower Extremity Free Tissue Transfer

PURPOSE: Atherosclerotic disease increases complications in lower extremity (LE) free tissue transfer (FTT). The use of saphenous vein interposition grafts (SViG) in atherosclerotic patients can produce flow-sparing end-to-side anastomosis in LE FTT. The aim of this current study is to evaluate long-term outcomes of SViG use in the setting of atherosclerotic disease. METHODS: A retrospective review was conducted on patients requiring LE FTT between 2011 and 2024. Patients with atherosclerotic recipient and/or donor vessels that were treated with an SViG were included. Patient characteristics, vascular details, intraoperative details, and postoperative outcomes were collected. The primary outcomes of interest were flap success and limb salvage. RESULTS: Out of 339 LE FTT, 38 (11.2%) utilized SViG. The SViG cohort had an average age of 60.4±11.6 years and Charlson Comorbidity Index of 4.9±2.2. Comorbid conditions included diabetes mellitus (n=32, 84.2%) and peripheral vascular disease (n=16, 42.1%). Fourteen patients (36.8%) required preoperative endovascular intervention. The most common flap type was anterolateral thigh (n = 22, 58.0 %), followed by vastus lateralis (n=13, 34.2%). There were 4 cases (10.5%) of takeback, of which 3 (75%) were salvaged. Flap success occurred in 36 cases (94.7%). By a median follow-up of 10 (IQR:19.0) months, 27 (73%) patients were ambulatory. CONCLUSION: The use of a SViG provides a reliable flow-sparing end to side technique for patients with diffuse atherosclerotic disease undergoing LE FTT. This technique extends the use of FTT LE reconstruction to patients who might otherwise be considered unsuitable candidates for limb salvage.