Fresh arterial homograft for bypass in critical limb ischaemia with infection

We present what we believe is Australia's first fresh peripheral arterial transplant for revascularisation of an ischaemic limb. Although cryopreserved homografts are accepted as a management option for revascularisation of critical limb ischaemia in infected fields, cryopreserved peripheral vascular tissue is not currently available in Australia. We describe a 72-year-old man without autologous conduit in whom infected prosthetic grafts were explanted, causing critical limb ischaemia of a below knee stump. Fresh peripheral arterial tissue was procured via the Australian organ donation authority, DonateLife, and was used to revascularise the stump with an axillofemoral bypass. This permitted successful healing of the stump within 6 weeks and mobilisation with a prosthesis. This case illustrates that fresh arterial homografts are a viable bridging solution for revascularisation of limb ischaemia with infection. However, it also highlights the need to establish a peripheral homograft bank so that cryopreserved conduits are readily available for similar scenarios.