Cryopreserved Saphenous Vein: Last-Ditch Conduit for Limb Salvage?

Abstract

In patients lacking autogenous vein suitable for infrainguinal bypass, cryopreserved saphenous vein (CSV) allograft (CryoLife Inc, Kennesaw, Ga) may be an acceptable alternative. However, long-term follow-up is lacking. The purpose of this study was to examine outcomes of CSV conduit for infrainguinal revascularization. Between February 2008 and August 2015, 72 patients underwent infrainguinal bypass grafts in 75 limbs using CSV. All patients were treated by a multidisciplinary limb preservation team and lacked suitable arm or leg vein. Demographic data and patient outcomes were retrospectively collected using electronic medical records. The mean age of our cohort was 70 ± 14 years, and 37 of 72 (51%) were male; 47 of 72 (65%) were white, 39 of 72 (54%) had coronary artery disease, 29 of 72 (40%) had diabetes, 57 of 72 (79%) had hypertension, and 52 of 72 (72%) were former or current smokers. Median follow-up was 304 days (interquartile range, 130-1051 days). Indications for the index operation included claudication (2%), rest pain (25%), tissue loss (53%), and prosthetic graft infection (17%); 62 of 75 (83%) bypasses were performed for critical limb ischemia, and 46 of 75 (61%) were revision operations. Distal targets included superficial femoral artery/popliteal (39%), tibial (54%), and pedal (7%). All grafts had a minimum diameter of 3 mm. At 30 days, 57 of 66 grafts (86%) were patent; 9 were lost to early follow-up. The only significant risk factor associated with 30-day failure was ABO mismatch (3 of 7 patients [43%] compared with 6 of 59 [10%]; P = .046). Estimated primary patency was worse in the tibial/pedal group (27%) compared with those bypasses to the superficial femoral artery/popliteal target (46%) (Fig). There were 20 (27%) major amputations, and all grafts in these limbs had occluded at the time of amputation. Of the 32 limbs with ischemic tissue loss that had long-term follow-up, 16 of 32 (50%) went on to graft occlusion, 9 of 32 (28%) had a major amputation, and 23 of 32 (72%) had complete healing of the index wound. The use of CSV for infrainguinal revascularization should be discouraged in patients with disabling claudication or rest pain. However, with an aggressive multidisciplinary approach including vigilant wound care and lack of autologous options, CSV may yield acceptable limb salvage. Avoiding ABO mismatch may improve 30-day graft patency.