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Abstract

In their letter Dardik and Turner suggest that our conclusion that implantation of human umbilical vein (HUV) graft should be confined to patients whose life expectancy is limited to a few years may be overly restrictive. They suggest that “the umbilical vein graft is the best alternative when no suitable saphenous vein is available.” They further suggest that HUV graft maintains patency “far in excess of other prosthetic materials.” We presented our series not to document incidence of prevalence statistics but rather to highlight a possible mechanism of HUV graft aneurysm formation. Our data support the studies of others, in particular Karkow et al.1Karkow WS Cranley JJ Cranley RD Hafner CD Ruoff BA. Extended study of aneurysm formation in umbilical vein grafts.J Vasc Surg. 1986; 4: 486-492PubMed Scopus (38) Google Scholar who suggest a significant incidence of aneurysms beginning at 3 years (33%), which increases over time. Hasson et al.2Hasson JE Newton WD Waltman AC et al.Mural degeneration in the glutaraldehyde-tanned umbilical vein graft: Incidence and implication.J Vasc Surg. 1986; 4: 243-250PubMed Scopus (52) Google Scholar and Nevelsteen et al.3Nevelsteen A Smet G Wilms G Marchal G Suy R. Intravenous digital subtraction angiography and Duplex scanning in the detection of late human umbilical vein degeneration.Br J Surg. 1988; 75: 668-670Crossref PubMed Scopus (14) Google Scholar also report high rates of degenerative changes beginning at 3 years after implantation. Although this degeneration and aneurysm formation may initially be asymptomatic, we nonetheless consider this a complication that may with extended follow-up lead to graft failure. Thus in patients whose life expectancy is 5 years, at least two authors1Karkow WS Cranley JJ Cranley RD Hafner CD Ruoff BA. Extended study of aneurysm formation in umbilical vein grafts.J Vasc Surg. 1986; 4: 486-492PubMed Scopus (38) Google Scholar, 2Hasson JE Newton WD Waltman AC et al.Mural degeneration in the glutaraldehyde-tanned umbilical vein graft: Incidence and implication.J Vasc Surg. 1986; 4: 243-250PubMed Scopus (52) Google Scholar suggest a greater than 50% chance of aneurysm formation in a patent graft at that interval. We feel this justifies our recommendation. We believe that other sources of autologous tissue (such as arm vein or lesser saphenous vein, alone or in combination) should be used in preference to any prosthetic material. With regard to the reports of patency of HUV grafts “far in excess” of other prosthetics, we hope to see further data confirming the single randomized study,4Eickhoff JH Broome A Ericsson BF et al.Four years' results of a prospective, randomized clinical trial comparing polytetrafluoroethylene and modified human umbilical vein for below-knee femoropopliteal bypass.J Vasc Surg. 1987; 6: 506-511PubMed Scopus (59) Google Scholar which addresses this issue.