The use of a tourniquet for lower limb revascularization is safe and effective and improves visualization of the operative field. Less dissection of the target vessels is required. With a combination of the nonuse of clamps and other occluding devices, we project a decrease in host hyperplastic response that will, in turn, impact favorably on patency rates. The possibility exists that early failure may be prevented by avoiding the application of traumatic forces to diseased and brittle or calcified arteries. In this study, tourniquet time had no impact on overall operative procedural time, although certain phases of the operation were clearly shortened and facilitated, particularly in complex and difficult reconstructions. Histochemical changes found in muscle biopsy specimens did not adversely impact patients clinically, but further investigation is required to elucidate subcellular events.

Our continuing experience with UVg confirms that favorable results can be obtained with this biologic alternative to autologous vein for lower limb revascularization. Concern regarding biodegradation and aneurysm formation even after 5 years are unfounded at this time. Improved patency and limb salvage rates can be achieved in concert with lower nonthrombotic failure rates, increasing performance of associated endovascular procedures, use of tourniquets, and the addition of dAVF for crural bypass grafting. Prospective randomized studies are still necessary for the assessment of the comparative role of all graft materials, a project that continues to evade our specialty.