title: Outcomes of cold-stored venous allograft for below-knee bypasses in patients with critical limb ischemia.
abstract: OBJECTIVE
  Critical limb ischemia (CLI), the most advanced form of peripheral arterial disease, is associated with strikingly high morbidity and mortality rates. Autogenous single-segment great saphenous vein (GSV) remains the optimal conduit for infrainguinal revascularization. Unfortunately, GSV is unavailable in up to 20% of patients. There is no consensus about the alternative graft that should be used for infragenicular bypass grafting when the GSV is unavailable. Currently, there are no outcome data for cold-stored venous allograft use in regard to recent safety and efficacy objective performance goals described by the Society for Vascular Surgery.
  
  
  METHODS
  This is a retrospective analysis of 118 infragenicular revascularizations performed for CLI with cold-stored venous allografts obtained from varicose vein stripping surgery in a single institution from November 2002 to August 2013.
  
  
  RESULTS
  Mean age (± standard deviation) was 75 ± 12 years (male, 76%; diabetes, 73%; dialysis, 16%), and 38% (n = 45) had a history of failed ipsilateral revascularization. None had suitable autogenous conduit for even composite vein bypass. The distal anastomosis was performed to an infrapopliteal artery in 85 cases (72%). At 30 days, perioperative death rate was 6.8%, major adverse cardiovascular event rate was 7.6%, and major adverse limb event rate was 11.9%. Mean follow-up was 34 ± 29 months (range, 1-113 months). At 1 year, freedom from major adverse limb event or perioperative death, limb salvage, survival, amputation-free survival, and secondary patency rates were, respectively, 64.9%, 82.5%, 85.4%, 73.3%, and 58.3%. Ejection fraction <45% and dialysis were the most significant factors predicting failure of revascularization.
  
  
  CONCLUSIONS
  Cold-stored venous allografts may be used for performing infragenicular revascularization for CLI with acceptable safety and efficacy results despite poor long-term patency. Their level of performance remains inferior to autologous vein sources but seems comparable to alternative allografts or prosthetic conduit. Their availability is a major advantage compared with other biologic alternative sources.
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France. Electronic address: vziza@club.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ziza
authors.affiliation: Department of Vascular and Thoracic Surgery, University Hospital, Montpellier, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gandet
authors.affiliation: Department of Medical Information, University Hospital, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France.
authors.forename: William
authors.initials: W
authors.lastname: Alonso
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France.
authors.forename: Robin
authors.initials: R
authors.lastname: Chastan
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Branchereau
authors.affiliation: Department of Vascular Surgery, University Hospital, Nîmes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Picard
mesh_terms: D000368:Aged; D064591:Allografts; D003080:Cold Temperature; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D012189:Retrospective Studies; D014021:Tissue Preservation / Q000379:methods*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000601:surgery; D014680:Veins / Q000637:transplantation*