Cryopreserved Saphenous Vein Allografts for Below-Knee Lower Extremity Revascularization

Martin, Raymond S.; Edwards, William H.; Mulherin, Joseph L.; Jenkins, Judith M.; Hoff, Steven J.

doi:10.1097/00000658-199406000-00009

Cited by 95 publications

(56 citation statements)

References 28 publications

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“…Preserved vein homografts tolerate repeated puncture by large dialysis needles. Similarly, when satisfactory autologous SVGs are not available, cryopreserved homologous SVGs, either cryopreserved or denatured, can be an alternative conduit to the autologous ones in coronary artery bypass,127 construction of aortopulmonary communication,77 a modified Blalock-Taussig shunt,7879 and complex limb-salvage procedures 128129. Some authors127130131 have suggested that use of such conduits should be limited due to poor patency.…”

Section: Discussionmentioning

confidence: 99%

A Reappraisal of Saphenous Vein Grafting

Yuan

Hua

2011

Annals of Saudi Medicine

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Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

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Section: Discussionmentioning

confidence: 99%

A Reappraisal of Saphenous Vein Grafting

Yuan

Hua

2011

Annals of Saudi Medicine

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“…In general, clinical use of cryopreserved venous and arterial allografts in lower extremity revascularization has been complicated by lower patency rates, aneurysmal dilatation, higher cost, and increased risk of bloodborne infectious diseases when compared to autogenous vein and prosthetic grafts. [25][26][27] Narayanan et al reported a 100% patency rate at 21 days in a rat model in which 5-mm-long and 1-mmdiameter cryopreserved femoral veins were used as interposition arterial grafts across major histocompatibility barriers without immunosuppression. 28 Similarly, Hirase et al reported a 100% patency rate of replanted rat hind limbs at 3 months utilizing 1.5-cm-long arterial and venous cryopreserved allografts.…”

Section: Cryopreserved Venous and Arterial Allograftsmentioning

confidence: 99%

New concepts and materials in microvascular grafting: Prosthetic graft endothelial cell seeding and gene therapy

Lio

1998

Microsurgery

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Microsurgical free tissue transfer is currently associated with very high success rates and few complications. While interposition vein grafting is clearly an important adjunct to the microsurgeon's armamentarium, it has been associated with higher free flap/replantation failures and complication rates. With appropriate flap planning and surgical techniques, the need for interposition vein grafting should be quite infrequent and hopefully avoided if at all possible. Nevertheless, when necessary, the vein graft remains the gold standard, with virtually all alternative interposition grafts demonstrating lower patency rates. One of the more promising areas of research is the concept of genetic manipulation of the endothelial cell via molecular biological techniques. It is likely that in the near future this may become a clinical reality, not only improving the patency of microsurgical anastomoses and interposition vein grafts, but quite possibly altering the target organ functionally as well.© 1998 Wiley-Liss, Inc. MICROSURGERY 18:263-266 1998Technical advances in microsurgical expertise, techniques, and suture materials have resulted in free flap success rates of greater than 99% in some clinical series. As microvascular surgery becomes more routine, there is an occasional need, despite preoperative planning, to bridge microvascular defects. Microvascular grafting is clearly an invaluable tool in digital replantation and free tissue transfer to essentially increase the length of the pedicle from the defect to the recipient vessels. The gold standard has long been and continues to be the autogenous vein graft. There is still some controversy regarding the patency rates of free flaps with and without vein grafts. While controlled rat model experiments have demonstrated comparable patency rates for microvascular procedures with and without vein grafts, 1 retrospective clinical reviews often demonstrate lower patency rates in flaps requiring venous interposition grafts.2 The added dissection, surgical time, and possible additional surgical scars of harvesting venous micrografts have led investigators to search for viable alternatives. In order to be considered a viable alternative to the autogenous vein graft, any substitute micrograft should equal the patency rate of vein grafts given the absolute consequences of a failed interpositional graft and subsequent free flap loss.Various synthetic and biologic alternatives to vein grafts have been tried experimentally but, in general, they are complicated by lower patency rates when used as interposition grafts in small diameter low flow vessels. The search for alternate micrografts can be divided into three basic categories: biologic grafts, synthetic or polymer prostheses, and a combination of the two. CRYOPRESERVED VENOUS AND ARTERIAL ALLOGRAFTSRenewed interest in the use of cryopreserved allografts in peripheral vascular surgery has led to several studies exploring the use of these allografts in microsurgery. In general, clinical use of cryopreserved venous and arterial ...

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“…However, insufficient donor tissue and questionable patency rates have limited their application. Cryopreserved saphenous veins have been reported to have poor patency rates and are used only when autologous conduits are not available [Martin et al, 1994;Nataf et al, 1995;Cheng and Slaughter, 2013]. The current options for small-diameter graft substitutes remain limited, particularly when the search is confined to synthetic or biological vessels.…”

Section: Introductionmentioning

confidence: 99%

Scaffolds and Cell-Based Tissue Engineering for Blood Vessel Therapy

Hsia

Yao

Chen

et al. 2016

Cells Tissues Organs

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The increasing morbidity of cardiovascular diseases in modern society has made it crucial to develop a small-caliber blood vessel. In the absence of appropriate autologous vascular grafts, an alternative prosthesis must be constructed for cardiovascular disease patients. The aim of this article is to describe the advances in making cell-seeded cardiovascular prostheses. It also discusses the combinations of types of scaffolds and cells, especially autologous stem cells, which are suitable for application in tissue-engineered vessels with the favorable properties of mechanical strength, antithrombogenicity, biocompliance, anti-inflammation, fatigue resistance and long-term durability. This article highlights the advancements in cellular tissue-engineered vessels in recent years.

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Cryopreserved Saphenous Vein Allografts for Below-Knee Lower Extremity Revascularization

Cited by 95 publications

References 28 publications

A Reappraisal of Saphenous Vein Grafting

A Reappraisal of Saphenous Vein Grafting

New concepts and materials in microvascular grafting: Prosthetic graft endothelial cell seeding and gene therapy

Scaffolds and Cell-Based Tissue Engineering for Blood Vessel Therapy

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