Suggested treatment protocol for improving patency of femoral-infrapopliteal cryopreserved saphenous vein allografts

Buckley, Clifford J.; Abernathy, Stephen; Lee, S.D.; Arko, Frank R.; Patterson, Donald E.; Manning, Larry G.

doi:10.1067/mva.2000.110049

Cited by 44 publications

(30 citation statements)

References 27 publications

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“…6 The risk for thrombosis is enhanced by rejection, leading to loss of endothelial lining and function, and in a later phase, by immune-related intimal hyperplasia and fibrosis. 7 Even the introduction of immunosuppressive therapy, 8 improvement of harvesting techniques and preservation fluids, 9 and the use of anticoagulation therapy 10 could not improve the patency rate of these allografts in most studies.…”

mentioning

confidence: 99%

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Randon

Jacobs

Ryck

et al. 2010

Journal of Vascular Surgery

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Objective: The availability of autologous vein grafts remains the limiting factor in infragenual bypass surgery in many patients with critical limb ischemia (CLI). Alternatives such as prosthetic conduits are known to have a poor outcome and most are not resistant to infection. Based on previous experimental work, we started to use cryopreserved saphenous vein allografts for this indication 15 years ago. To evaluate their outcome, we performed a retrospective study of those bypasses with distal anastomosis on a crural or pedal vessel. Methods: Between November 1991 and December 2005, 108 cryopreserved great saphenous vein allografts were implanted for in 92 patients (42 women, 50 men) with a mean age of 71 years (range, 39-88 years). All patients received low-dose immunosuppressive therapy for up to 1 year after intervention. Follow-up was conducted until amputation, death, or the end of the study in March 2007. Results: Nondiabetic atherosclerosis the cause of CLI in 57%, 41% had diabetes, and 2% had Buerger disease. Forty-one conduits were performed for primary reconstructions and 67 for redo reconstructions. During a mean follow-up of 26.4 months, 69 occlusions occurred. Primary and secondary patency rates were 56% and 73% at 1 year, 32% and 60% at 3 years, and 17% and 38.5% at 5 years. Survival rates were 87.4% at 1 year and 64.5% at 5 years. At multivariate analysis, the intake of statins was predictive for improved patency (hazard ratio [HR], 0.09; P = .024) and for prolonged survival (HR, 0.335; P = .045). The presence of diabetes showed a trend for inferior patency (HR, 2.325; P = .116) and for decreased amputation risk (HR., 0.592; P = .078). Conclusion: Cryopreserved saphenous vein allografts are a valuable alternative to prosthetic materials when autologous veins are not available. Our limb salvage and patency rates are higher then those described for prosthetic grafts at the infrapopliteal level in most studies. Moreover, these grafts are resistant to infection when performed for revascularization in patients with an infected ulcer. Better graft and patient selection, better graft surveillance and immunologic matching, and standard use of statins could possibly improve the results even further. Shortage in availability might be a limiting factor for their widespread use

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mentioning

confidence: 99%

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Randon

Jacobs

Ryck

et al. 2010

Journal of Vascular Surgery

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“…The limb salvage rate in this study was 88% at 6 months and 80% at 24 months. 21 Although this report demonstrated improved patency, it enrolled a small number, and patients required high levels of anticoagulation to obtain the results.…”

Section: Biologic Conduits: Allograftsmentioning

confidence: 85%

Damage Control

Singh¹,

Quan²

2016

Rich's Vascular Trauma

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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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Suggested treatment protocol for improving patency of femoral-infrapopliteal cryopreserved saphenous vein allografts

Cited by 44 publications

References 27 publications

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Damage Control

A Reappraisal of Saphenous Vein Grafting

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