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Reoperation for complications of stabilized human umbilical vein grafts
1Surgical Service, Montefiore Hospital, Pittsburgh, Pennsylvania.
Insights
Stabilized human umbilical vein grafts showed few major complications. Prompt treatment of graft closure, including thrombectomy, led to successful outcomes in most cases.
Area of Science:
- Vascular Surgery
- Biomaterials Science
Background:
- The use of stabilized human umbilical vein (SHUV) grafts for femoropopliteal bypass has been explored.
- Understanding the long-term outcomes and complication rates is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the major complications and outcomes of femoropopliteal bypass grafts constructed with SHUV.
- To assess the efficacy of interventions for graft complications.
Main Methods:
- A retrospective review of 211 femoropopliteal bypass grafts using SHUV constructed between 1977 and 1986.
- Analysis of complication rates (thrombosis, aneurysm, infection) and treatment outcomes.
Main Results:
- Three major complications were observed: graft thrombosis, aneurysm formation, and infection.
- Early thrombosis (n=17) had an 82% success rate with thrombectomy or replacement.
- Late graft closure (n=28) was successfully treated in 61% with thrombectomy and 14% with revision/replacement.
- Aneurysms (3%) were successfully reconstructed in 6/7 instances; infections (3%) led to amputation in 6/7 patients.
Conclusions:
- Stabilized human umbilical vein grafts demonstrate a manageable complication profile.
- An aggressive approach to graft closure, utilizing thrombectomy or revision, is recommended for SHUV grafts.
- While aneurysms are treatable, graft infections pose a significant risk of limb loss.
Abstract:
Among 211 femoropopliteal bypass grafts constructed with stabilized human umbilical vein performed between 1977 and 1986, 3 major complications were seen: graft thrombosis, aneurysm formation, and infection. Early thrombosis (within 30 days of operation) was successfully treated in 14 of 17 patients (82 percent) with either graft thrombectomy (13 of 17 patients) or graft replacement (1 patient). Late graft closure (2 to 55 months after operation) was successfully treated with thrombectomy in 17 of 28 patients (61 percent) or graft revision or replacement in 4 patients (14 percent). Aneurysms and graft infections were each seen in 3 percent of the grafts at risk. The former were successfully reconstructed in six of seven instances, whereas the latter eventuated in amputation in six of seven patients. An aggressive approach to graft closure in stabilized human umbilical vein grafts is recommended as this conduit is amenable to thrombectomy or revision if closure occurs.