Early experience with cryopreserved arterial allografts in below-knee revascularization for limb salvage

Below-knee revascularization for limb salvage in the absence of a suitable autogenous saphenous vein is a frequent challenge associated with a high amputation rate. The aim of this prospective study was to evaluate the usefulness of cryopreserved arterial allografts in such cases.

Arterial allografts were harvested from multiple organ donors and cryopreserved at -80 degrees C. From March 1993 to December 1997, 35 cryopreserved arterial allografts were used as below-knee bypasses for repeated limb salvage in 32 patients. There were 15 men and 17 women with a mean age of 75 years (+/-10.7). Seven patients had rest pain and 25 patients (78%) had gangrene or nonhealing ulceration. Runoff was through a single tibial vessel in 25 cases (71%) and two vessels in 10 cases. Previous ipsilateral bypasses had been done in 26 of 35 limbs (74%). Patients were followed up prospectively for an average period of 18 months (range 2 to 56).

Aneurysmal dilatation occurred in two patent grafts, requiring segmental replacement at 13 and 18 months, respectively. The overall primary patency rate was 75% at 6 months, 57% at 12 months, and 39% at 18 months. The overall secondary patency rate was 75% at 6 months, 75% at 12 months, and 59% at 18 months. Overall limb salvage rate was 80% at 12 months, 73% at 18 months.

These early data indicate that below-knee bypass with arterial allografts results in acceptable patency and limb salvage. Arterial allografts may be a useful alternative to other arterial substitutes in a difficult group of patients with critical ischemia and no suitable saphenous vein.