Long-term assessment of cryopreserved vein bypass grafting success

When autogenous vein is unavailable, cryopreserved veins have been used in patients as a means of attempted limb salvage. We evaluated the long-term patency and limb salvage rates for patients undergoing bypass grafting with cryopreserved veins.

Medical records were reviewed for patients undergoing cryovein bypass grafting at two hospitals from 1992 to 1997. Follow-up data were obtained from subsequent admissions and office records. Primary outcomes were death, amputation, and primary patency. Skin integrity and additional bypass grafting procedures were assessed when data were available. Analysis was performed by means of life-table and chi(2) analyses with the Statistical Package for Social Sciences (SPSS).

Seventy-six patients (mean age, 70 +/- 11 years) underwent 80 procedures. Indications for surgery were tissue loss (63%), rest pain (24%), acute ischemia (11%), and other (2%). Early complications included 3 deaths (4%), 14 acute thromboses (18%), and 7 major amputations (9%). The mean follow-up period was 17.8 +/- 20.89 months (range, 0-77 months). The primary patency rate was determined to be 36.8% at 1 year and 23.6% at 3 years by means of life-table analysis. The limb salvage rate was 65.5% at 1 year and 62.3% at 3 years. Skin integrity was found to be compromised in 17 (55%) of 31 patients who were available to follow-up. Nine patients (11.3%) underwent additional ipsilateral revascularization or revisions, with one of three of these patients eventually requiring a major amputation.

Cryopreserved vein may be a reasonable alternative conduit for limb salvage when no autogenous tissue is available; it has an acceptable limb salvage rate (62.3%) at 3 years. Long-term patency remains relatively poor, with only 23.6% of originally placed grafts patent at 3 years. The use of cryopreserved veins should be strictly confined to limb salvage after a thorough search for autogenous tissue has been exhausted.