Glutaraldehyde-stabilized umbilical vein prosthesis for revascularization of the legs: Three year results by life table analysis

Abstract

Three hundred sixty-one vascular reconstructions for salvage of the leg were performed from 1975 to 1978 employing glutaraldehyde-stabilized umbilical veins. These included 183 bypasses to the popliteal segment, 108 to either of the tibial arteries and 70 to the peroneal artery. One hundred forty-one (77 per cent) of the popliteal reconstructions were below the knee. Operative mortality rates were 2.7,2.8, and 4.3 per cent for popliteal, tibial, and peroneal reconstructions, respectively. The cumulative patency rates at 36 months for each of the three types of reconstructions were 76.4 (popliteal), 63.4 (tibial), and 39.8 per cent (peroneal). The latter figure was statistically insignificant because of the small number of patients between 24 and 36 months. The cumulative patency rate for peroneal reconstructions at 2 years was 55.7 ± 6.2 per cent. Failures were usually due to inappropriate case selection or progressive disease, particularly in the distal circulation. Two grafts were removed because of wound infection and secondary graft infection. There were no instances of aneurysm formation or myointimal proliferation in the graft. These data support the continued use of the glutaraldehyde-stabilized umbilical vein as a suitable alternative to the autologous saphenous vein. The graft provides a reliable material for reconstruction of the leg that is nonantigenic, mechanically equivalent to normal vascular structures, and biocompatible as determined by physical and chemical modalities. The durability of these grafts is based on the thromboresistance of the flow surface and the cross-links established by aldehyde processing. In appropriately selected cases and with expert surgical technique, long-term graft function with limb salvage can be obtained.