Sequential femorodistal composite bypass with second generation glutaraldehyde stabilized human umbilical vein (HUV)

To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein.

Retrospective study of consecutive patients, in a single centre.

From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein.

All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient survival.

Primary patency and secondary patency rates at 1, 2, 3 and 4 years were 71, 61, 53 and 53% and 89, 80, 73 and 67%, respectively. Corresponding limb salvage rates were 96, 92, 88 and 88%. Patient survival was 56% at 4 years. After 30 days additional procedures to maintain graft patency were necessary in six bypasses. Asymptomatic occlusion of one sequential anastomosis was found in five patients.

Graft patency and limb salvage rate support the use of the sequential composite technique with second generation HUV in femorodistal bypass surgery, when autologous vein of sufficient length is not available.