Femorodistal Bypass Using Cryopreserved Venous Allografts for Limb Salvage

Lesèche, Guy; Penna, Christophe; Bouttier, Samuel; Joubert, Sylvie; Andréassian, B

doi:10.1007/s100169900039

Cited by 35 publications

(20 citation statements)

References 22 publications

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“…[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Comparison was made difficult because these grafts were used for different indications (some for replacement of infected grafts) and because different methods of harvesting, preservation, and immunosuppressive therapy were used. Through careful graft selection, meticulous immunosuppressive therapy with cyclosporine, and careful follow-up, we could obtain 1-year secondary patency comparable with the best published results.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Arterialization of venous grafts is reflected by neointimal hyperplasia (NH), but may occur excessively or uncontrolled at the proximal anastomosis site, resulting in highly rigid lesions requiring aggressive treatment such as cutting balloon angioplasty or surgery enabling secondary patency rates of 45-63 % at 12 months (Kreienberg et al 2007;Leseche et al 1997;Zehr et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Neointimal hyperplasia in allogeneic and autologous venous grafts is not different in nature

Albert

Hartmann

Wagner

et al. 2015

Histochem Cell Biol

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Neointimal hyperplasia, transplant rejection and thus immunogenicity of allografts are possible reasons for poorer patency rates in cryopreserved venous allografts for peripheral bypass surgery in comparison with autologous venous grafts. To expand the limited knowledge from human allografts, we histologically investigated allogeneic and autologous venous grafts in arterial location. Specimens of allogeneic and autologous venous graft stenosis, harvested 6 months after bypass implantation, were immunohistochemically characterized. Examination of the lesions showed a uniform morphological pattern. A continuous endothelial layer, tissue fibrosis and a thickened neointima with monocytes and dedifferentiated vascular smooth muscle cells were seen in both conduits with very low cell turnover and the absence of acute and chronic inflammation. Neoangiogenesis with CD34-positive endothelium was abundant in the vessel media. The morphological patterns of allogeneic and autologous neointima formation are similar. Consequently, neointimal hyperplasia in venous grafts may reflect a uniform physiological host response of non-immunological factors with the reasons for poorer clinical outcome of cryopreserved allografts yet to be elucidated.

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“…For below-knee bypass, Selke et al 25 and Walker et al 26 reported secondary patency rates of 33% at 20 months and 37% at 18 months, respectively. For infrapopliteal bypass, Leseche et al 27 and Martin et al 28 reported 52% at 1 year and 11% at 4 years, respectively.…”

Section: Discussionmentioning

confidence: 98%

Venous Allografts Preserved at 4°C for Infrainguinal Bypass: Long-Term Results from 170 Procedures

Streinchenberger

Barjoud

Adeleine

et al. 2000

Annals of Vascular Surgery

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Femorodistal Bypass Using Cryopreserved Venous Allografts for Limb Salvage

Cited by 35 publications

References 22 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

Neointimal hyperplasia in allogeneic and autologous venous grafts is not different in nature

Venous Allografts Preserved at 4°C for Infrainguinal Bypass: Long-Term Results from 170 Procedures

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