Cryopreserved Arterial and Venous Allograft for Infrainguinal Bypass in Chronic Critical Limb Ischemia

Abstract

Introduction: In critical limb ischemia the first choice for open revascularization procedure is infrainguinal surgery with autologous vein. However, due to lack of adequate veins, in 20-30 percent of patients an alternative conduit is required for limb salvage surgery. Synthetic prosthesis implantation is an option, but long term results are poor. Cryopreserved human arteries and veins have been used in infected cases, but there is a lack of data regarding allografts in non-infected cases. Our objective was to analyse the results of infrainguinal bypass surgery using allografts for critical lower limb ischemia. Methods: We performed retrospective analyses of patients with critical limb ischemia, who underwent infrainguinal bypass surgery with allografts in a tertiary care university center between 2007 and 2017. Mann-Whitney U-test and Kaplan-Meier analysis with log-rank test were performed for statistical analysis. Results: During an 11-year period, infrainguinal allograft implantations were performed in 134 cases for critical limb ischaemia [91 males (67.9%)]. The mean age of patients was 66.4 ± 9.9 years. Great saphenous veins were implanted in 100 cases and superficial femoral arteries in 34 cases. The average postoperative hospital stay was 13.6 ± 5.6 days. Thirty-day mortality was 2.98%. Early postoperative complications occurred in 17.1% of patients. Thirty-day reoperation rate was 10.44% and late intervention was necessary in 15.67% of cases. After allograft implantation, graft infection was confirmed in 2 cases (1.49%). Five-year occlusion rate of implanted superficial femoral arteries was significantly lower as compared with saphenous vein (p=0.002). Major amputation rates at 1, 3 and 5 years after surgery were 26%, 35% and 37%, respectively. The long-term survival rate was 47% at 5 years. Conclusion: In critical limb ischemia, allograft implantation is a reasonable option for limb salvage. Late amputation rate and long term mortality remain high. The ideal choice of allograft for revascularization is superficial femoral artery since the long term patency is better when compared to saphenous veins. Disclosure: Nothing to disclose