title: Cryopreserved saphenous vein graft in infrainguinal bypass.
abstract: OBJECTIVE
  Autogenous saphenous vein is the ideal conduit for lower extremity revascularization. Unfortunately, autogenous vein is unavailable in up to 20% of patients. Synthetic grafts provide an alternative; however, their use in distal revascularization has shown varying results. In addition, infected surgical sites preclude their use. Currently, there are limited outcome data for cryopreserved saphenous vein use in regard to long-term patency and limb salvage rates.
  
  
  METHODS
  Cryopreserved saphenous vein allograft use in infrainguinal bypass was studied retrospectively in a community setting. End points included primary patency, limb salvage, and early complications. Records of patients receiving cryopreserved allografts by nine vascular surgeons within one hospital system from 2006 to 2012 were reviewed.
  
  
  RESULTS
  Fifty-three patients, mean age 69 years (standard deviation, 12.3; range, 28-90 years), underwent 60 operations. Indications for surgery included limb-threatening ischemia (48%), tissue loss (30%), previous graft or site infection (10%), claudication (7%), or other (5%). The mean follow-up period was 23.9 months (standard deviation, 21.0; range, 0-64 months). Primary patency was maintained in 53% of patients at 1 year and in 22% at 3 years. Limb salvage was achieved in 74% of patients at 1 year and in 70% at 2 years. Thirteen early complications included 8 thromboses, 2 deaths, 2 amputations, and 1 anastomotic disruption. Fifteen patients (28%) underwent additional ipsilateral operations with use of synthetic conduits after initial cryopreserved allografts failed.
  
  
  CONCLUSIONS
  Cryopreserved vein allografts displayed poor short-term and long-term patency, whereas limb salvage rates at 1 and 2 years remained acceptable. However, >25% of patients required additional ipsilateral operations with use of synthetic conduits after previous failed cryopreserved allograft use. Our data indicate that cryopreserved vein graft is a suboptimal choice of conduit in a noninfected field.
authors.affiliation: Department of Surgery, Mount Carmel Health System, Columbus, Ohio. Electronic address: charles.hartranft@gmail.com.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Hartranft
authors.affiliation: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors.forename: Seth
authors.initials: S
authors.lastname: Noland
authors.affiliation: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors.forename: Aaron
authors.initials: A
authors.lastname: Kulwicki
authors.affiliation: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Holden
authors.affiliation: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hartranft
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D015925:Cryopreservation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009820:Ohio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014654:Vascular Patency