Sequential Femoral Distal Composite Bypass with Second Generation Glutaraldehyde Stabilized Human Umbilical Vein (HUV)

Abstract

Conclusion: Limb salvage and graft patency rates with sequential composite bypasses composed of second generation human umbilical vein grafts and autogenous vein provide reasonable primary and secondary patency rates and are associated with excellent limb salvage. Summary: The authors sought to evaluate a policy of using a combination of second generation human umbilical vein (HUV) grafts and autogenous vein as a sequential conduit in patients felt to have inadequate autogenous conduit for construction of an all autogenous lower extremity bypass. This was a retrospective study from a single center in Germany. From January 1998 to December 2003, 1,231 infrainguinal bypasses were performed in this center. Of those, 54 consisted of a femoral-distal HUV-autologous vein sequential composite bypass. All patients had critical leg ischemia and were felt to have an absence of sufficient length of autogenous vein. The sequential HUV-composite technique was reviewed for graft patency, limb salvage, and patient survival. Primary and secondary patency rates at 1, 2, 3 and 4 years were 71, 61, 53 and 53%, and 89, 80, 73 and 67% respectively. Limb salvage rates at 1, 2, 3, and 4 years were 96, 92, 88 and 88%. Four year survival was 56%. After one month, additional graft based procedures were required in six bypasses. Five patients had asymptomatic occlusion of one sequential anastomosis. There were no identified complications related to bio-degeneration of the HUV graft. Comment: There still remains some interest in the use of human umbilical vein grafts. The author’s technique of using human umbilical vein grafts as the prosthetic component of a prosthetic/autologous sequential composite bypass has provided reasonable results in terms of both patency and limb salvage. The results differ little from what one would expect with similar procedures with PTFE grafts. Bio-degeneration of the HUV grafts in this series of limb salvage patients appeared to be a non issue. If a sequential composite autogenous graft is required it appears to make little difference whether the prosthetic component is PTFE or human umbilical vein.