Cryopreserved saphenous vein as a last-ditch conduit for limb salvage

Abstract

Objective: In patients lacking autogenous vein suitable for infrainguinal bypass, cryopreserved saphenous vein (CSV) allograft (CryoLife, Inc, Kennesaw, Ga) may be an acceptable alternative. The purpose of this study was to examine outcomes of CSV conduit for infrainguinal revascularization.

Methods: Between February 2008 and August 2015, 70 patients underwent infrainguinal bypass grafts in 73 limbs using CSV. All patients lacked suitable arm or leg vein. Demographic data and patient outcomes were retrospectively collected using electronic medical records.

Results: The mean age of our cohort was 70 ± 14 years, and 36 (51%) were male; 47 (67%) were white, 39 (56%) had coronary artery disease, 27 (39%) had diabetes, 56 (80%) had hypertension, and 50 (71%) were former or current smokers. Median follow-up was 304 days (interquartile range, 130-991 days). Indications for the index operation included rest pain (27%), tissue loss (55%), and prosthetic graft infection (18%); 62 of 73 (85%) bypasses were performed for critical limb ischemia, and 45 of 73 (62%) were redo operations. Distal targets included superficial femoral artery or popliteal (38%), tibial (55%), and pedal (7%). All grafts had a minimum diameter of 3 mm. At 30 days, 55 of 64 grafts (86%) were patent; 9 were lost to early follow-up. The only significant risk factors associated with 30-day failure were ABO mismatch (43% vs 10%; P = .05) and donor blood type B or AB (40% vs 9%; P = .03). Estimated overall 1-year primary patency was 35%. In a multivariate analysis, nonblack race (P = .05), donor B or AB blood type (P = .01), and bypass to a tibial or pedal target (P = .05) were independently associated with loss of primary patency. There were 20 (27%) major amputations, and all grafts in these limbs had occluded at the time of amputation. Of the 33 limbs with ischemic tissue loss that had long-term follow-up, 17 of 33 (52%) went on to graft occlusion, 10 of 33 (30%) had a major amputation, and 24 of 33 (73%) had complete healing of the index wound.

Conclusions: In the setting of a multidisciplinary team with aggressive wound care, CSV may be a reasonable choice for infrainguinal revascularization in patients with ischemic tissue loss who lack autogenous conduit. However, poor midterm to long-term patency suggests that optimal selection of patients is needed to derive meaningful clinical benefit.