WHAT THIS STUDY ADDS Recent long-term results of arterial allografts used for distal bypasses in the setting of chronic ischaemia are lacking. This study confirms that the use of modern cryopreserved arterial allografts allows for an excellent limb salvage rate, at the cost of a relatively high re-intervention rate. This material should be considered as a valuable alternative to prosthetic material when no venous material is available. Objective/Background: In critical limb ischaemia (CLI), current guidelines recommend revascularisation whenever possible, preferentially through endovascular means. However, in the case of long occlusions or failed endovascular attempts, distal bypasses still have a place. Single segment great saphenous vein (GSV), which provides the best conduit, is often not available and currently there is no consensus about the best alternative graft. Methods: From January 2006 to December 2015, 42 cryopreserved arterial allografts were used for a distal bypass. Autologous GSVs or alternative autologous conduits were unavailable for all patients. The patients were observed for survival, limb salvage, and allograft patency. The results were analysed with KaplaneMeier graphs. Results: Estimates of secondary patency at one, two and five years were 81%, 73%, and 57%, respectively. Estimates of primary patency rates at one, two and five years were 60%, 56%, and 26%, respectively. Estimates of limb salvage rates at one, two and five years were 89%, 89%, and 82%, respectively. Estimates of survival rates at one, two and five years were 92%, 76% and 34%, respectively. At 30 days, major amputations and major adverse cardiac events were one and zero, respectively. Six major amputations occurred during the long-term follow up. Conclusion: Despite a low primary patency rate at two years, the secondary patency of arterial allografts is acceptable for distal bypasses. This suggests that cryopreserved arterial allografts are a suitable alternative for limb saving distal bypasses in the absence of venous conduits, improving limb salvage rates and, possibly, quality of life.

Introduction-95% of those operated on for popliteal artery aneurysm (PA) are men. Thus, PA in women is difficult to investigate. The aim was to study the disease in women. Methods-Women treated for PA 1987-2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case-records, compared with the greater male cohort. Survival was determined through cross-linkage with the National Population Registry. Results-1509 patients (men and women), 1872 legs, were identified; 74 women, 4.9%, and 81 female legs, 4.3%. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time-trends in the proportion of women operated on (p¼0.5), despite that a screening program for aortic abdominal aneurysm (AAA) in men started in Sweden 2006. Bilateral PA occurred in 9.5% in women and 27.0% in men (p¼0.002). The age distribution was proportional with median 70 years in women versus 69 in men. Distribution between asymptomatic and symptomatic PA was 31% versus 69%, similar to men. The size of PA in women was normally distributed in the symptomatic group but in the asymptomatic group there was a concentration around two cm. The prevalence of concomitant aneurysms in the aorto-iliac and femoral arteries was similar compared to men. Three PA were ruptured (3.7%). Thrombolysis was used in 23 of 45 legs treated for acute ischemia (51.1%). Eight legs were treated with endovascular stent grafts (9.8%), compared to 7,9% in men, p¼0.5. Amputation frequency were 9,5% in women and 7.3 in men (p¼0.512). Crude survival was similar to men. Conclusion-PA is similar in women and men, but bilateral disease was less common in women. Women had the same survival as men, despite women should have better lifeexpectancy. Although the largest series ever published on women with PA, the sample size is small, making it prone to type II statistical error.