Venous Allografts Research Articles

Emphysematous Pyelonephritis as a Presentation of Delayed Venous Allograft Thrombosis

Emphysematous Pyelonephritis as a Presentation of Delayed Venous Allograft Thrombosis

Possibilities of Surgical Interventions in Severe Lower Limb Ischemia in the Stage of Trophic Disorders

Occlusive pathology in the branches of aortic bifurcation or linear remains an urgent task of endovascular surgery in all highly developed countries throughout the world due to atherosclerotic narrowing of the vessels especially in the lower extremities. We have described the possibilities of surgical elimination of critical limb ischemia (CLI) in the stage of trophic disorders through the cohort study, which was conducted in the Grodno university clinic. The hospital and university committee approved the study. Within the last two years 2020-2022 in the hospital a total number of 68 patients were surgically treated for the CLI with trophic disorders. All of them were staged III-IV according to R.Fontine - A.V. Pokrovsky staging and ankle-brachial index (ABI). Aorto-femoral, Infrainguinally femoro-popliteal-tibial revascularization and transplantation of autologous venous allograft for the reconstruction of the lower extremities in the above mentioned patients were carried out. We obtained a very positive results, in 97.1% the patients had a limb with positive dynamics and its functional state was preserved. Only in 2 patients out of 66 which is 2.9%, the limb was amputated due to complications developed and inadequate revascularization. Based on our clinical observation we have proposed that, the use of autogenous venous material, modern original deobliterating reconstructions of arterial vasculature and transplantable allograft structures may be promising in the amelioration of occlusive pathology in severe life threatening lower limb ischemia in the stage of trophic disorders

Valved Conduit for Norwood-Sano Procedure

Use of a valved Sano (VS) during the Norwood procedure has been reported previously, but is not widely used and its impact on clinical outcomes needs to be further elucidated. Our institution shifted practice to the VS operation entirely in 2019, using a valved femoral venous homograft. We describe our technique in the present report. The VS technique is well codified and highly reproducible. Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the VS patients (n = 16/25, 66.7%). We retrospectively reviewed 25 consecutive HLHS neonates who underwent a Norwood procedure with a VS conduit using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a Norwood procedure with a non-valved Sano (NVS) conduit between 2013 and 2022. Hospital survival for the VS group was 96%. Postoperatively, VS patients had significantly lower peak and postoperative day 1 lactate levels (p=0.033 and p=0.025 respectively), shorter time to diuresis (p=0.043), and shorter time to enteral feeds (p=0.038). The VS group had significantly fewer PA reinterventions until the Glenn (n=1 vs 8; p=0.044). The VS group showed significant improvement in ventricular function from the immediate post-operative period to discharge (p<0.001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the VS group, but a significant reduction of ventricular function in the NVS group (p=0.003). The use of a valved conduit for Norwood-Sano procedure is a reproducible technique, associated with improved multi-organ recovery, ventricular function recovery and fewer PA reinterventions.

Valved Sano conduit improves immediate outcomes following Norwood operation compared with nonvalved Sano conduit

ObjectiveUse of a valved Sano during the Norwood procedure has been reported previously, but its impact on clinical outcomes needs to be further elucidated. We assessed the impact of the valved Sano compared with the nonvalved Sano after the Norwood procedure in patients with hypoplastic left heart syndrome. MethodsWe retrospectively reviewed 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a valved Sano conduit using a femoral venous homograft and 25 consecutive neonates with hypoplastic left heart syndrome who underwent a Norwood procedure with a nonvalved Sano conduit between 2013 and 2022. Primary outcomes were end-organ function postoperatively and ventricular function over time. Secondary outcomes were cardiac events, all-cause mortality, and Sano and pulmonary artery reinterventions at discharge, interstage, and pre-Glenn time points. ResultsPostoperatively, the valved Sano group had significantly lower peak and postoperative day 1 lactate levels (P = .033 and P = .025, respectively), shorter time to diuresis (P = .043), and shorter time to enteral feeds (P = .038). The valved Sano group had significantly fewer pulmonary artery reinterventions until the Glenn operation (n = 1 vs 8; P = .044). The valved Sano group showed significant improvement in ventricular function from the immediate postoperative period to discharge (P < .001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the valved Sano group, but a significant reduction of ventricular function in the nonvalved Sano group (P = .003). Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the valved Sano group (n = 16; 67%). ConclusionsThe valved Sano is associated with improved multi-organ recovery postoperatively, better ventricular function recovery, and fewer pulmonary artery reinterventions until the Glenn procedure.

Association Between Venous Homografts and Allosensitization After Norwood Procedure.

Right ventricle (RV) to pulmonary artery (PA) shunts have become the shunt of choice at many centers for use during the Norwood procedure for single ventricle palliation. Some centers have begun to use cryopreserved femoral or saphenous venous homografts as an alternative to polytetrafluoroethylene (PTFE) for shunt construction. The immunogenicity of these homografts is unknown, and potential allosensitization could have significant implications on transplant candidacy. All patients undergoing Glenn procedure at our center between 2013 and 2020 were screened. Patients who initially underwent Norwood procedure with either PTFE or venous homograft RV-PA shunt and had available pre-Glenn serum were included in the study. The primary outcome of interest was panel reactive antibody (PRA) level at the time of Glenn surgery. Thirty-six patients met inclusion criteria (N = 28 PTFE, N = 8 homograft). Patients in the homograft group had significantly higher median PRA levels at the time of Glenn surgery (0% [IQR 0-18] PTFE vs 94% [IQR 74-100] homograft, P = .003). There were no other differences between the two groups. Despite potential improvements in PA architecture, the use of venous homografts for RV-PA shunt construction at the time of Norwood procedure is associated with significantly elevated PRA level at the time of Glenn surgery. Centers should carefully consider the use of currently available venous homografts given the high percentage of these patients who may require future transplantation.

Long-term Results of Portal Vein Reconstruction with Venous Homograft Interposition in Paediatric Split Liver Transplantation for Biliary Atresia

Long-term Results of Portal Vein Reconstruction with Venous Homograft Interposition in Paediatric Split Liver Transplantation for Biliary Atresia

Prognostic Value of Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Carcinoma Followed by Pancreatectomy with Portal Vein Resection and Reconstruction with Venous Allograft.

Neo-adjuvant chemotherapy (NAC) represents one of the current research hotspots in the field of pancreatic ductal adenocarcinoma (PDAC). The aim of this study is to evaluate the prognostic value of NAC in patients with borderline resectable pancreatic cancer (BRPC) followed by pancreatectomy with portal vein (PV) resection and reconstruction with venous allograft (VAG). Medical records of patients with BPRC who underwent pancreatectomy with concomitant PV resection and reconstruction with VAG between April 2013 and March 2021 were analyzed retrospectively. Outcomes of patients with and without NAC (NAC, Group 1 vs. non-NAC, Group 2) were compared with focus on R0 resection rates, morbidity, and survival. Of the 77 patients with pancreatectomy, PV resection and reconstruction with VAG were identified. Overall survival (OS) rates of 0.5-, 1-, and 2-year were 80.5%, 59.7%, and 31.2%, respectively (median survival time, MST, 14 months). Of these, 24 patients (Group 1) underwent operation following received NAC, and the remaining 53 patients did not (Group 2). The R0 resection rate of vascular margin was 100% vs. 84.9% (p = 0.04), respectively. Morbidity of post-operative pancreatic fistula (POPF) was 0% vs. 17.8% (p = 0.07), respectively. The OS of 0.5-, 1- and 2-year and MST of 2 groups were 83.3%, 66.7%, 41.7%, 16 months, and 79.2%, 55.6%, 26.4%, 13 months, respectively. Multivariate analysis revealed that carbohydrate antigen 19-9 (CA19-9) serum level and postoperative chemotherapy were independent prognostic factors in patients with BRPC after surgery. NAC might improve the R0 resection rate and POPF in patients with BRPC who underwent pancreatectomy with concomitant PV resection and reconstruction with VAG. Survival benefit exists in patients with BRPC who received NAC before pancreatectomy. Postoperative chemotherapy also had a favorable effect on OS of BRPC patients. Elevated CA 19-9 serum level is associated with poor prognosis, even after NAC-combining operation.

Comparison of arterial and venous allograft bypass in chronic limb-threatening ischemia.

IntroductionFemoro-popliteal bypass with autologous vascular graft is a key revascularization method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable autologous conduit may occur in 15–45% of the patients, necessitating the implantation of prosthetic or allogen grafts. Only little data is available on the outcome of allograft use in CLTI.AimsOur objective were to evaluate the long term results of infrainguinal allograft bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare the results of arterial and venous allografts.MethodsSingle center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017.ResultsDuring a 11-year period, 134 infrainguinal allograft bypasses were performed for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases, superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001; 3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001). Both primary and secondary patency of SFA allograft implanted in below-knee position were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively). Limb salvage at one, three and five years following surgery was 74%, 64% and 62%, respectively. Long-term survival was 53% at 5 years.ConclusionAllograft implantation is a suitable method for limb salvage in CLTI. The patency of arterial allograft is better than venous allograft patency, especially in below-knee position during infrainguinal allograft bypass surgery.

Evaluation of Arterial and Venous Allografts in Subinguinal Bypasses

Autologous saphenous vein (ASV) is the preferred conduit for below-the-knee bypasses in patient with critical limb-threatening ischemia (CLTI). Alternative graft must be considered for patients without (ASV). The aim of this work is to evaluate the mid-term performance of arterial (AA) and venous allografts (VA) used as an alternative conduit. This retrospective study included patients with CLTI, with or without a history of homolateral femoropopliteal bypass and no autologous veins were available who underwent infra-inguinal arterial reconstructions using VA or AA from 2008 to 2018. Patients undergoing revision operations for infected bypasses were excluded. Primary patency (PP), primary assisted patency (PAP), secondary patency (SP), major amputation and death from any cause were the endpoints. For each event, a set of analyses were performed. Overall, 111 patients (63 VA and 48 AA) were included, with 108 having below-the-knee bypass. The median follow-up time was 27.8 months [15.6; 37.4]. The difference in PP between the two allograft types was significant (p=0.049) with 65.9% [43.7; 81.0], 44.1% [24.2; 62.3] and 44.1% [24.2; 62.3] in the AA group respectively at 6, 12 and 18 months while 55.6% [40.0; 68.6], 46.0% [30.6; 60.2] and 33.2% [18.2; 49.0] in the VA group. The choice of an AA over a VA was an independent factor associated with patency (for PP: HR=0.43 [0.24; 0.75] (p=0.003), PAP: HR=0.52 [0.30; 0.89] (p=0.018), SP: HR=0.49 [0.27; 0.88] (p=0.016). The allograft type did not affect neither the incidence of major amputation nor death from any cause (respectively, HR=1.20 [0.49; 2.93], and 0.88 [0.37; 2.14]). The nature of the allograft appears to influence the patency of infra-inguinal reconstruction, but not the course of the disease. Performant alternative grafts answering infectious issues are needed.

Fresh Cold-Stored Vascular Allografts in Subgenicular Location: Our Experience with Rescue Endovascular Techniques

Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency. A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July2021. We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68years (49min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P<0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1month, 51.9% after 12months, 24.2% after 3years, 9.8% after 5years. Limb salvage was 72.6% in 1year, 53% in 3years, 36.5% in 5years, respectively. Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative.

Portal Vein Reconstruction Using Cryopreserved Veins in Pancreatoduodenectomy for Advanced Pancreatic Head Carcinoma

Introduction: For advanced pancreatic head carcinoma, removal and reconstruction of the portal vein and/or the superior mesenteric vein are sometimes necessary to achieve R0 resection. Our institute has Tissue-Bank stocking the cryopreserved venous allografts donated based on the voluntary wish after the cardiac death. We have utilized these grafts to various surgeries with combined vascular resection. Methods: We retrospectively reviewed medical records of the 23 cases undergoing pancreatoduodenectomy with the combined resection of the portal venous systems and reconstructed it using the venous grafts for advanced pancreatic carcinoma between January 2002 and December 2019. Results: There were 12 male and 11 female, aged 73 (31-81), (median and range, same applies hereafter). Operative time was 749 (610-1148) min, estimated blood loss was 1305 (690-4350) gram. The type of portal vein resection consisted of 13 cases of circumferential segmental resection, 10 cases of wedged resection. Median postoperative hospital stay was 30 (18-105) days. There was no surgical complication greater than Clavien-Dindo IIIb. Five cases of postoperative occlusion of the allografts were observed. Graft patency rate in six months after the surgery was 75.0% and no occlusion later than 6 months were detected. Overall survival rate in one, three, and five years were 71.9%, 36.0%, 30.0% respectively. Conclusions: Reconstruction of portal vein using cryopreserved venous allografts is safe and its therapeutic effects is feasible for the pancreatoduodenectomy for advanced pancreatic carcinoma. Our techniques will be shown with a short videoclip.

Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus

We report a case of a mycotic abdominal aortic aneurysm caused by invasive group B streptococcus. Given the anatomical suitability with healthy segments of aortoiliac vessels, in situ repair was performed. A cryopreserved femoral vein graft was chosen because of risks of graft reinfection and negated the need for bilateral femoral vein harvest. The patient remained clinically well and the graft patent with no concerns at 6 months of follow-up. A review of literature on group B Streptococcus aortitis was performed.

Remembering an Old Technique: Retroscrotal Perineal Femorofemoral Bypass for Ischaemic Ulcer of the Anterior Thigh

A 61 year old male (after multiple previous bilateral peripheral arterial procedures and fenestrated endovascular aortic aneurysm repair) consulted for buttock claudication and ischaemic ulceration of the anterior right thigh. Computed tomography angiography showed patent common and external iliac arteries, common and superficial femoral arteries (previously stented), and occlusions of right internal iliac, deep circumflex iliac, and proximal deep femoral arteries. After failed endovascular attempts, a femorofemoral crossover bypass was performed using a cryopreserved venous allograft. Owing to ischaemic necrosis of the thigh, perineal retroscrotal tunnelling was preferred. Dual antiplatelet therapy was initiated post-operatively. Tunnelling in this lesser known region allowed successful wound healing after several months.Image 1

Six month evaluation of the BIOPROTEC venous allografts in the REVATEC registry

Bioprotec venous allografts are widely used but their precise evaluation is lacking.

Aneurysm of a Fresh Venous Allograft After 12 Years

Aneurysm of a Fresh Venous Allograft After 12 Years

Cryopreserved Venous Allografts in Supra-inguinal Reconstructions: A Single Centre Experience

This study introduces a novel technique for supra-inguinal arterial reconstructions with cryopreserved femoral vein and caval allografts with a low re-infection rate and an acceptable graft re-intervention rate on early mid term analysis.

Analysis of Failure-mechanisms of Cryopreserved Vascular Allografts in Peripheral Reconstructions

Introduction: Cryopreserved vascular allografts represent a well known option in the treatment of vascular infections. Moreover several groups also suggested their use in case of patients with no suitable veins requiring an infragenicular bypass. The aim of the present study was to evaluate the failure mechanisms of cryopreserved allografts in peripheral reconstructions in a cohort of patients treated at a single Institution. Methods: We retrospectivly analized a prospectively collected database comprising all patients undergoing a peripheral reconstruction with cryopreserved arterial or venous allografts between August 2010 and January 2019. The composite result of graft failure (occlusion + degeneration + any graft-related complication) was calculated as a primary endpoint. In case of reintervention hystological analysis of a segment of allograft was performed. Results: A total of 20 patients [mean age 66.1 +/- 10.3 yy, M 66% (12/18)] underwent 25 vascular in-situ reconstruction with cryopreserved arterial or venous allografts. Indication for treatment was infection of a previous prosthetic graft in 12 cases, critical limb ischemia in 8, allograft degeneration in 3 and mycotic pseudoaneurym in 2. Type of reconstruction are reassumed in table I Table I. Type o.... In 17 cases an arterial allograft was used (11 single segment, 6 multiple segments) and in 8 cases a vein allograft (6 single segment, 2 multiple segments). At 30 days there were 3 deaths (1 myocardial infarction, 1 rupture of thoracic aortic aneurysm, 1 anastomotyc disrupture) with 2 additional deaths during follow up (1 drug overdose, 1 intestinal ischemia). Mean follow-up was 31 months (min 1 - max 81) with no patients lost to follow up. Overall graft failure occurred in 7 cases (28%) (3 aneurysmal degenerations, 2 occlusions, 2 anastomotyc disrupture) with reintervention with allograft performed in 4 cases. There was no statistical difference in the incidence of the composite endpoint between venous and arterial grafts [OR 0.71 (0.098 - 5.2), p 1], between patients with infection and without infection [OR 1.8 (0.26 - 12), p 0.66] and between single and multiple segments grafts [OR 2.8 (0.42 - 2.9), p 0.34], although occlusions occurred only in veins (2/8, 25%) and aneurismal degeneration only in arterial allografts (3/17, 17%). Hystological analysis was available for 5 allografts: 2 anastomotyc disruptures showing wall necrosis due to infection, 3 aneurysmal degenerations showing a chronic flogistic pattern suggestive of immune-mediated rejection. Kaplan-Meier estimates showed an overal 26% of freedom from graft failure at 60 months, with no difference between patients with and without infection and venous and arterial allografts (Logrank test p: 019 and 0.26 respectively). Conclusion: In our series the failure rate of allografts was not low, although their use was limited to very high risk situations. Accurate follow up is mandatory as the risk of aneurysmal degeneration is not negligible with arterial allografts, although they seem to offer a better patency rate compared to veins. Immune-mediated rejection plays a role in aneurysmal degeneration while uncontrollable infection greatly hinders the early postoperative outcome.Table IType of peripheral reconstruction with allografts and type of allografts usedType of ReconstructionN (%)Type of allografts (N)Composite axillo-femoral bypass1 (4%)Single Arterial (1)Femoral tibial bypass4 (16%)Multiple Arterial (2) Single Venous (1) Multiple Venous (1)Femoral femoral crossover bypass2 (8%)Single Arterial (2)Below knee femoral popliteal bypass5 (20%)Single Arterial (1) Multiple Arterial (3) Single Venous (1)Above knee femoral popliteal bypass2 (8%)Single Arterial (1) Single Venous (1)Iliac femoral bypass3 (12%)Single Arterial (2) Multiple Arterial (1)Femoral truncal bypass2 (8%)Single Venous (1) Multiple Venous (1)Common femoral reconstruction4 (16%)Single Arterial (3) Single Venous (1)Bypass of a dilated segment of a previous allograft2 (8%)Single Arterial (2) Open table in a new tab Disclosure: Nothing to disclose

Durability and Infection Resistance of Cryopreserved Femoral Vein Allografts in Suprainguinal Position. A Single Center Study

Introduction - There is no consensus about the best treatment method of aortic graft infections (AGI) and primary arterial infections in aorto-iliac area. Cryopreserved arterial allografts have proved to be infection-resistant, but long-term durability is altered by late graft thrombosis and degeneration 1,2. However, cryopreserved big caliber venous allografts’ performance in aorto-iliac position is unknown. The aim of current study was to evaluate cryopreserved femoral vein allografts’ (CVA) safety, infection resistance and durability in suprainguinal setting in infectious conditions and compare their performance with cryopreserved arterial allografts (CAA) from the same homograftbank. Methods - Patients treated from February 2012 to March 2018 with cryopreserved allografts’ reconstruction due to infection encompassing suprainguinal area in a tertiary level hospital were retrospectively reviewed. Preoperative characteristics, indication for operation, operative details, early postoperative morbidity and mortality, late mortality, re-infections and graft re-interventions during the follow-up were recorded. Univariable analysis was done using crosstabs method, survival calculated with Kaplan-Meier method. Results - 31 patients underwent cryopreserved venous (femoral vein, n=21; cava vein, n=2) or arterial (superficial femoral artery, n=6; aorta, n=1; iliac artery, n=1) allograft reconstruction due to infection in aorto-iliac area. Indications for treatment were AGI in 14 (45%), mycotic aneurysm in 5 (16%), extra-anatomical prosthetic infection in 5 (16%), secondary arterial infection with rupture in 2 (6%), anastomotic pseudoaneurysm in 2 (6%) and aortic thrombosis with intestinal spillage in 1 (3%) case. 30-day and overall treatment-related mortality was 4 (13%). During the median follow-up of 15 month, two CAAs were treated due to thrombosis, two CVAs due to anastosmotic dilatation and one CVA due to re-infection and subsequent rupture making re-intervention incidence 16% (n=5). None of the grafts were lost and there were no amputations. At the end of follow-up 22 (71%) patients were alive. Kaplan-Meier estimation of survival was 87% (95% confidence interval, 81% to 93%) at 1 year and 63% (52% to 74%) at 2 years. Univariable analysis revealed no risk factors significantly associated with 30-day mortality, however cerebrovascular disease (p=0,028) was associated with treatment-related mortality and renal insufficiency (p=0,004) with overall total mortality. Due to small number of patients statistical analysis comparing CAA and CVA were unreliable, but two acute arterial occlusions call for caution and further research. Conclusion: Cryopreserved venous allografts appear safe, infection-resistant and durable reconstruction material in aorto-iliac axis based on single center experience and mid-term analysis. Further research is needed to compare their performance to cryopreserved arterial allografts and other biological reconstruction material.

Result of Cold Stored Venous Graft for Popliteal Aneurysm

Introduction - Popliteal aneurysm are the most common of peripheral aneurysm and accounting for at the least 70% of them. Autogenous great saphenous vein (GSV) remains the optimal conduit for popliteal aneurysm treatment. Therefor GSV is unavailable in up to 20% and sometimes present a great under sizing in comparison with the arteries in those patients. The aim of this study was to evaluate the safety and efficacy of the cold stored vein bypass in this indication. Methods - This is a retrospective analysis of 20 exclusions of popliteal aneurysm with cold stored venous allografts in a single institution between January 2007 to December 2017. Results - The mean age was 80,4 (+/-9,7) years , all patients were males. None had a suitable autogenous conduit for a vein by pass. Seventy percent of patients ( n=14) were treated for acute or critical limb ischemia. The distal anastomosis was performed to an infrapopliteal artery in 13 cases (65%). At 30 days, perioperative death rate was 10% (n = 2) and major adverse limb event was 20% (n=4). the mean follow-up was 34,15(+/-30.5) months ; at 1 year freedom for major adverse limb or perioperative death , survival , amputation free survival, primary and secondary patency rates were, respectively, 75%, 85%, 85%, 55% and 60% . Three patients had a major amputation with a permeable bypass. Acute ischemia was the most significant factor predicting failure of revascularisation. Conclusion - Cold stored allograft may be used for popliteal aneurysm treatment with safety and efficacy, this conduit may be usefully in emergency when its available. Their ease of use and avaibility are a major advantage compared with other biologic alternative sources.

Long-Term Outcomes of Cold Stored Venous Allografts in Infrainguinal Arterial Revascularization

Introduction - Cold stored venous allografts (CSVA) are one of the alternatives grafts that could be used for the infrainguinal bypass grafting when the autologous veins are unavailable. The aim of this study was to evaluate the long-terme outcomes of patients underwent infrainguinal bypass grafting using CSVA.