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

Abstract

Introduction Femoro-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. Aims Our 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. Methods Single center, retrospective study analysing the outcomes of infrainguinal allograft bypass surgery in patients with CLTI between January 2007 and December 2017. Results During 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. Conclusion Allograft 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 vascular repair by tissue-engineered human acellular vessels or expanded polytetrafluoroethylene grafts in a porcine model of limb ischemia and reperfusion

“… 26 A recent comparison between cryopreserved cadaveric allografts used for femoro-popliteal bypass in chronic limb threatening ischemia showed promising long-term primary patency in femoral artery allografts versus saphenous vein allografts (71% vs. 30% at 5 years). 27 This trend is similar for animal-derived xenografts implanted for arterial repair in that bovine artery (Artegraft; LeMaitre Vascular, Burlington, MA) has higher patency rates 28 than bovine vein (ProCol, LeMaitre Vascular, Burlington, MA), which is also prone to aneurysmal failure under higher-pressure arterial blood flow. 29 Tissue-engineered HAV may provide the off-the-shelf convenience and consistency of synthetic grafts, but with the biocompatibility, infection resistance, and mechanical strength of native blood vessels.…”

“…Cryopreserved cadaveric blood vessels are occasionally used when ePTFE is contraindicated in potentially contaminated wounds, but concerns of patient immunoreactivity and often highly variable performance, in addition to higher cost and preparation time, limit their utility 26 . A recent comparison between cryopreserved cadaveric allografts used for femoro-popliteal bypass in chronic limb threatening ischemia showed promising long-term primary patency in femoral artery allografts versus saphenous vein allografts (71% vs. 30% at 5 years) 27 . This trend is similar for animal-derived xenografts implanted for arterial repair in that bovine artery (Artegraft; LeMaitre Vascular, Burlington, MA) has higher patency rates 28 than bovine vein (ProCol, LeMaitre Vascular, Burlington, MA), which is also prone to aneurysmal failure under higher-pressure arterial blood flow 29 .…”