Umbilical vein bypass in patients with severe lower limb ischemia: a report of 121 consecutive cases.
In 112 patients with severe ischemia of the lower limb and without a suitable saphenous vein, 99 femoropopliteal and 22 femorodistal bypass procedures were performed with the modified human umbilical vein (Biograft, Meadox Medicals Inc., Oakland, N.J.). Seventy-eight percent of the operations were performed for limb salvage. In the remaining 22% the indication was severe disabling claudication. Forty-nine percent of the patients had previously undergone arterial reconstruction of the extremity in question. In 36% the distal anastomosis was to the popliteal artery above the knee, in 46% to the popliteal artery below the knee, and in 18% to one of the crural arteries. It was mandatory to perform an additional proximal reconstruction in 38% of the extremities. The observation time ranged from 6 to 60 months, with a mean of 24 months. Two patients died within the first month. The overall cumulative patency rate calculated by the life table method was 67.7% at 1 year, 61.2% at 2 years, and an unchanged 56.6% at 3 to 5 years. The cumulative patency rate in the limb salvage group was higher (58.6%) than the patency rate of the grafts implanted for claudication (46.5%, not significant). Graft patency decreased the more peripherally the distal anastomosis was situated, but we could demonstrate neither a significant relationship between graft patency and runoff nor any prognostic significance in the peroperatively measured flow values. Limb salvage calculated by the life table method was 86% at 1 year and 75.4% at 5 years. It is concluded that the umbilical vein graft is an acceptable alternative for bypass grafting in patients without a suitable autogenous vein.
D000368:Aged; D000671:Amputation, Surgical; D001161:Arteriosclerosis / Q000150:complications / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology; D014471:Umbilical Veins / Q000637:transplantation*