Ten Year Experience of Using Cryopreserved Arterial Allografts for Distal Bypass in Critical Limb Ischaemia

Abstract

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.

Immunological Aspects Involved in the Degeneration of Cryopreserved Arterial Allografts

“…We have to take into consideration that the use of cryopreserved arteries was indicated in challenging situations concerning critical ischemia and native or prosthetic vascular infection, which are associated with an important risk of amputation, morbidity and mortality. Several studies have reported similar outcomes (13,42), with an emphasis on the dissociation between distal bypass patency and medium to long-term limb and patient survival. This is especially significant, as some authors report that only 45% of patients with critical limb ischemia will remain alive and with both legs 1 year after the diagnosis (43).…”

In vivo recellularization of xenogeneic vascular grafts decellularized with high hydrostatic pressure method in a porcine carotid arterial interpose model

“…For patients requiring revascularization surgery, unavailability of autologous bypass grafts may lead to loss of an opportunity for appropriate therapy and consequent poor prognosis. Although cryopreserved arterial allografts can be a surrogate for autologous small-caliber grafts with acceptable long-term patency, the availability is rather limited because of the shortage of donors and insufficient operation of organ / tissue banks to preserve and provide allografts [16][17][18]. The present study was designed to address this healthcare problem through validating the feasibility of xenogeneic implantation of HHP-decellularized vascular grafts using bovine arterial grafts and a porcine carotid arterial interpose model.…”

Possibilities of Vascular Transplantation in Urgent Surgery of Main Arteries

“…По данным S. Masmejan et al [13], хорошие результаты возможны при реконструкции артерий нижних конечностей криоконсервированными аллографтами с отсутствующей аутовеной у 38 пациентов. Из 42 шунтов проксимальный анастомоз был выполнен в бедренную артерию в 41 случае (98%), дистальный анастомоз был выполнен в 21 случае (50%) в большеберцовые артерии, в тибиоперинеальный ствол -в девяти случаях (21%) и в дистальную подколенную артерию в 12 случаях (28%).…”