LEA 19. Venous Allograft Transplantation From Living Donor as a Last Resort for Limb Salvage

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The rate of endovascular procedures for limb salvage in peripheral vascular disease is increasing. Long and below-knee endovascular repairs have low patency rates. In these cases of endovascular failure, distal bypasses are performed for limb salvage. Venous bypass is preferred because of superior long-term patency. Synthetic grafts for distal bypasses have a very low patency rate and are not recommended. We present two cases in which endovascular and bypass repairs occluded and the limbs were at risk of amputation. On angiography, a distal tibial artery was demonstrated without any available autologous veins. To save the limb with long-term patency, a venous graft was required. In these cases, we performed allogeneic vein transplantation from living donor (family related or genetic matched) from femoral artery to distal tibial artery. Both the donors and recipients were screened for infectious diseases and compatibility. Patients with known malignant disease, infection, or contraindication to immunosuppression were excluded. The saphenous vein was dissected at the donor and transplanted to the recipient leg, and femorotibial bypass was performed. In both cases, an arteriovenous fistula was created between the tibial artery and the vein proximal to the bypass anastomosis. Technical success was achieved in both cases. No major complications occurred during the procedures, and at 6-month follow-up, both bypasses remained patent. The patients returned to normal daily activity after the procedure, and ischemic wounds healed. Allogeneic vein bypasses have been previously reported; however, their use is scarce. We suggest venous allograft transplantation from living donor to patients with no endovascular solutions or autologous vein for revascularization for limb salvage. It has been shown that chemical vein preparation or cryogenic vein preservation has deleterious effects and decreases graft patency rates. Immunosuppressive therapy should be administered to avoid graft rejection. We recommend complementary arteriovenous fistula to the allogeneic vein bypass for outflow augmentation. Multiorgan harvest may provide a viable opportunity for vein harvest. Allograft vein transplantation should be considered for limb salvage in such cases.