title: Infrapopliteal composite bypass with autologous vein and second generation glutaraldehyde stabilized human umbilical vein (HUV) for critical lower limb ischaemia.
abstract: OBJECTIVE
  To audit a single center consecutive series of infrapopliteal composite bypasses with second generation glutaraldehyde stabilized human umbilical vein.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  From January 1996 to July 2006 89 femoro-distal bypasses were constructed in 85 patients with HUV and residual vein segments as composite grafts in the absence of sufficient length of autologous vein.
  
  
  METHODS
  All patients with infrainguinal bypass operations were registered prospectively. Bypasses to infrapopliteal arteries performed with HUV-composite grafts were reviewed for graft patency, limb salvage, patient survival and possible biodegeneration of the HUV.
  
  
  RESULTS
  Early graft thrombosis was noted in 21.3%, necessitating revision surgery. Primary, primary assisted and secondary patency rates were 35%, 40% and 42% respectively, with a limb salvage rate of 87% after 5 years. Graft infection occurred in 7 limbs. Aneurysmal HUV graft degeneration was not detected by duplex scanning.
  
  
  CONCLUSIONS
  HUV-composite bypasses provide acceptable patency and favorable limb salvage rates. Patency was similar to previous series using PTFE-composite bypasses but was significantly inferior to vein bypass. Possible biodegradation of the HUV grafts seems to be of minor clinical relevance.
authors.affiliation: Departments of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University School of Medicine, Mainz, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Neufang
authors.forename: C
authors.initials: C
authors.lastname: Espinola-Klein
authors.forename: B
authors.initials: B
authors.lastname: Dorweiler
authors.forename: S
authors.initials: S
authors.lastname: Savvidis
authors.forename: W
authors.initials: W
authors.lastname: Schmiedt
authors.forename: C F
authors.initials: CF
authors.lastname: Vahl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D015897:Comorbidity; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014471:Umbilical Veins / Q000637:transplantation*; D014654:Vascular Patency