Femoropopliteal prosthetic bypass with glutaraldehyde stabilized human umbilical vein (HUV).
OBJECTIVE
Femoropopliteal bypass still is the standard surgical therapy for disabling claudication and critical ischemia. When autologous vein is not suitable synthetic or biological prostheses may be considered. Second generation glutaraldehyde tanned human umbilical vein (HUV) graft was chosen for above and below knee femoropopliteal bypass when autologous vein was not available. A single center experience regarding long-term graft function, secondary reinterventions, and potential biodegeneration of the HUV is presented.


METHODS
Between January 1994 and January 2005, 211 consecutive femoropopliteal bypass operations with HUV (65 above knee and 146 below knee) were performed in 197 patients for disabling claudication (57), chronic critical ischemia (130), popliteal artery aneurysm (9), acute ischemia (14), or aneurysmal degeneration of a synthetic graft (1) in the absence of suitable ipsilateral great saphenous vein. Grafts were followed with duplex scan supplemented by additional angiography in case of recurrent ischemia with prospective documentation of follow-up data in a computerized vascular database. Surveillance of the HUV included routine evaluation of potential biodegeneration with duplex scan. Retrospective analysis of graft patency, limb salvage, and signs of aneurysmal degeneration was performed.


RESULTS
Mean (median) follow-up was 44 (35) months (range 1 to 143 months). Thirty-day mortality was 2.4%. Early postoperative bypass thrombosis after a median of 4 days postoperatively (0 to 30 days) prompted revision with thrombectomy in 16% of cases. Besides late bypass thrombosis in 14.7%, additional operative or endovascular reinterventions during follow-up to maintain or restore graft patency was necessary in 8.5% of bypasses. Primary, primary assisted, secondary patency rate, and limb salvage rate after 5 years were 54%, 63%, 76%, and 92%, respectively, for all bypasses with no significant difference between above and below knee anastomosis. Duplex scan identified segmental aneurysmal degeneration in six grafts, which led to operative reintervention in three cases. The rate of detected aneurysm for grafts patent for more than three years was 7% with a rate of reintervention for aneurysm of 3.5%.


CONCLUSIONS
Although a considerable rate of early thrombotic occlusions occurred, excellent secondary graft patency and limb salvage combined with a tolerable rate of late aneurysmal degeneration detected by means of duplex scan surveillance justify the use of the HUV in femoropopliteal bypass surgery when ipsilateral autogenous vein is not suitable.
Neufang
Achim
A
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University School of Medicine, Mainz, Germany. neufang@mail.uni-mainz.de
Espinola-Klein
Christine
C
Dorweiler
Bernhard
B
Messow
Claudia Martina
CM
Schmiedt
Walther
W
Vahl
Christian Friedrich
CF
D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005404:Fixatives; D005500:Follow-Up Studies; D005976:Glutaral; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016707:Tissue Fixation / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014471:Umbilical Veins / Q000000981:diagnostic imaging / Q000637:transplantation*; D014654:Vascular Patency
D005404:Fixatives; D005976:Glutaral