Cryopreserved saphenous vein allografts in infrainguinal revascularization: analysis of 240 grafts.
BACKGROUND
Cryopreserved saphenous vein allografts (Cryograft; CryoLife, Kennesaw, Ga) have been used as conduit in infrainguinal revascularization when autogenous vein is inadequate or unavailable. Although some studies of Cryografts report poor long-term patency, an anticoagulation protocol may improve outcome. We evaluated our experience with Cryografts to further define their role in lower extremity revascularization. Patients and methods Between March 1992 and March 2002, 240 infrainguinal revascularization procedures with Cryografts were performed in 199 limbs of 177 patients. Eighty-nine percent of procedures were performed because of ischemic rest pain or tissue loss, and 75% of vein grafts were implanted into infrapopliteal targets. Most patients received anticoagulation therapy with warfarin sodium or aspirin, or both, postoperatively. Mean age of the cohort was 78 years; 61% were women; 75% had hypertension, 58% had diabetes, and 38% had renal dysfunction; and 47% were current or past smokers.


RESULTS
Mean follow-up was 7 months (range, 0-48 months). Primary patency rate was 83% at 1 month, 50% at 6 months, 30% at 12 months, and 18% at 24 months. Diabetes adversely affected graft patency. Warfarin sodium or antiplatelet therapy did not significantly improve graft patency. Limb salvage was 80% at 1 year and 71% at 2 years.


CONCLUSIONS
Cryografts have low primary patency rates that are not affected by anticoagulation with warfarin sodium. Short-term patency of these grafts may be sufficient to heal ischemic wounds and thereby prevent limb loss. However, other less expensive alternatives, eg, prosthetic grafts with vein cuffs, are available and appear to have better patency. Accordingly, use of Cryografts should be limited to revascularization through infected fields in patients without autogenous conduit.
Farber
Alik
A
Section of Vascular Surgery, Cedars-Sinai Medical Center, 8631 W Third St, #615E, Los Angeles, CA 90048, USA. alik@aol.com
Major
Kevin
K
Wagner
Willis H
WH
Cohen
J Louis
JL
Cossman
David V
DV
Lauterbach
Stephen R
SR
Levin
Philip M
PM
D000368:Aged; D015925:Cryopreservation; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation*; D014184:Transplantation, Homologous