What is the patency rate for a femoral to peroneal artery bypass using the great saphenous vein (GSV) in older adults with a history of smoking, hypertension, diabetes, and hyperlipidemia?

Femoral to Peroneal Artery Bypass with GSV: Patency Rates

For femoral-tibial (including peroneal) artery bypass using great saphenous vein (GSV), you can expect a 5-year primary patency rate of 74-80%, which is substantially superior to prosthetic grafts that achieve only 25% patency at 3 years. 1

Evidence-Based Patency Data

GSV Conduit Performance for Tibial Bypasses

• The ACC/AHA guidelines establish that femoral-tibial artery bypasses with autogenous vein achieve 74-80% primary patency at 5 years 1
• This represents the gold standard for distal arterial reconstruction to tibial vessels, including the peroneal artery 1
• GSV demonstrates superior long-term durability compared to all synthetic alternatives for below-knee reconstructions 1

Comparative Performance: GSV vs. Prosthetic

The evidence strongly favors autogenous vein for all infrainguinal bypasses, particularly to tibial targets:

• Prosthetic grafts to tibial vessels achieve only 25% patency at 3 years, making them dramatically inferior to GSV 1
• For above-knee bypasses, GSV achieves 66% 5-year patency versus 50% for prosthetic grafts 1
• For below-knee bypasses, GSV achieves 66% 5-year patency versus only 33% for prosthetic grafts 1

Clinical Context for Your Patient Population

In patients with smoking history, hypertension, diabetes, and hyperlipidemia (your specified population):

• The ACC/AHA strongly recommends autogenous vein for all femoral-tibial bypasses (Class I, Level of Evidence B) 1
• GSV should be sourced from the ipsilateral greater saphenous vein first, or if unavailable, from contralateral leg or arm veins 1
• The presence of diabetes and other risk factors accelerates prosthetic graft failure but does not significantly diminish GSV performance 1

Critical Technical Considerations

Conduit Selection Algorithm

Use GSV whenever anatomically available, regardless of vein caliber or perceived quality 2:

• Historical data demonstrates that GSV can be used successfully in 97% of cases requiring femoropopliteal/tibial bypass 2
• Even "marginal" quality GSV achieves 81.9% patency at 5 years 2
• Only 2.7% of patients truly lack usable saphenous vein 2

Factors Accelerating Graft Failure

Be aware that certain anatomic factors worsen outcomes, particularly with prosthetic grafts 1:

• More distal anastomoses (such as to the peroneal artery) accelerate prosthetic graft failure 1
• Hemodynamically significant tibial arterial occlusive disease and poor outflow tract reduce patency 1
• These factors make GSV use even more critical for peroneal artery targets 1

Contemporary Evidence Supporting GSV Superiority

Recent Validation Studies

A 2023 multi-center analysis of the Vascular Quality Initiative database demonstrated that GSV use is associated with improved freedom from loss of primary patency, reduced major amputation, and improved long-term survival 3:

• Centers using GSV in >50% of cases had better outcomes than centers using GSV in <30% of cases 3
• Both low GSV utilization (hazard ratio 1.35) and prosthetic graft use (hazard ratio 1.24) were independent multivariable risks for mortality 3

Systematic Review Findings

A systematic review of 25 studies comparing saphenous vein to PTFE conclusively rejected the null hypothesis that both conduits are equivalent (p=0.008) 4:

• After 5 years, venous bypasses achieved 69% primary patency versus 49% for PTFE 4
• This superiority held true even in patients with anticipated short life expectancy (<2 years) 4

Common Pitfalls to Avoid

Do Not Prematurely Abandon GSV

• Surgeons often underutilize available GSV, with institutional use rates ranging from 0% to 100% across centers 3
• Do not reject GSV based on small caliber or perceived poor quality—use it liberally 2
• Consider contralateral leg or arm vein sources before resorting to prosthetic conduit 1

Recognize Accelerated Prosthetic Failure in Tibial Position

• With distal anastomoses to tibial vessels (including peroneal), there is accelerated failure of prosthetic grafts 1
• The 25% 3-year patency for prosthetic femoral-tibial bypass makes it an unacceptable first-line option when GSV is available 1

Specific Answer to Your Question

For femoral to peroneal artery bypass with GSV in your patient population (older adults with smoking, hypertension, diabetes, hyperlipidemia), expect 74-80% primary patency at 5 years 1. This represents the best available conduit option and should be used whenever anatomically feasible, as prosthetic alternatives achieve only 25% patency at 3 years in this anatomic position 1.