Great Saphenous Vein Availability in Lower‑Extremity Arterial Disease: Analysis of a Prospectively Mapped Nonselective Cohort

Purpose: This study aimed to quantify the real-world availability of a single-segment great saphenous vein (GSV) in a nonselective Korean cohort with peripheral arterial disease and to identify patient-level predictors that may limit the adoption of a vein-first strategy. Materials and Methods: This retrospective analysis of prospectively collected data included 115 consecutive patients admitted for evaluation and planning of lower-extremity revascularization (53 with claudication and 62 with chronic limb-threatening ischemia [CLTI]) from 2023 to 2024. All patients underwent mandatory bilateral duplex mapping before treatment by registered vascular technologists under a standardized protocol (reverse Trendelenburg position, temperature 25°C-26°C, inner-to-inner measurements). A suitable single-segment conduit was defined as a continuous, thrombus-free GSV from the saphenofemoral junction to the proximal calf without duplex-detected reflux and was categorized by minimum diameter as ideal (≥3.0 mm), acceptable (≥2.5 mm), or borderline (≥2.0 mm). Results: In the ipsilateral limb, the GSV met the ideal, acceptable, and borderline thresholds in 23/115 (20.0%), 39/115 (33.9%), and 57/115 (49.6%) patients, respectively. When the contralateral limb was included, overall availability (either limb) increased to 28/115 (24.3%), 58/115 (50.4%), and 75/115 (65.2%), corresponding to absolute gains of 4.3, 16.5, and 15.6 percentage points, respectively. Ipsilateral and overall ideal availability tended to be lower in CLTI than in claudication (14.5% vs. 26.4%, P=0.112 for ipsilateral; 17.7% vs. 32.1%, P=0.074 for overall). On multivariable analysis, older age and female sex were independently associated with reduced overall ideal availability (adjusted odds ratio [aOR] per year, 0.932; 95% confidence interval [CI], 0.887-0.979; female sex: aOR, 0.201; 95% CI, 0.046-0.869). Conclusion: In this consecutive real-world cohort, ideal single-segment GSV availability (≥3.0 mm) was low and was further limited by older age and female sex. These findings highlight an important limitation of a vein-first strategy in routine practice and support standardized bilateral mapping to clarify conduit availability and guide individualized revascularization planning.