Ten Year Experience of Using Cryopreserved Arterial Allografts for Distal Bypass in Critical Limb Ischaemia

Area of Science:

• Vascular Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Critical limb ischemia (CLI) management often prioritizes endovascular revascularization.
• Distal bypass remains crucial for CLI when endovascular options fail or for long occlusions.
• Great saphenous vein (GSV) availability is limited, necessitating alternative conduits for distal bypass.

Purpose of the Study:

• To evaluate the efficacy of cryopreserved arterial allografts as an alternative conduit for distal bypass in CLI patients.
• To assess the outcomes of cryopreserved arterial allografts in terms of survival, limb salvage, and graft patency.
• To determine the suitability of arterial allografts for limb-saving procedures when autologous venous conduits are unavailable.

Main Methods:

• A retrospective analysis of 42 patients undergoing distal bypass with cryopreserved arterial allografts from 2006 to 2015.
• Patients lacked autologous great saphenous veins or alternative autologous conduits.
• Kaplan-Meier analysis was used to estimate survival, limb salvage, and allograft patency rates.

Main Results:

• Secondary patency rates at 1, 2, and 5 years were 81%, 73%, and 57%, respectively.
• Primary patency rates at 1, 2, and 5 years were 60%, 56%, and 26%, respectively.
• Limb salvage rates at 1, 2, and 5 years were 89%, 89%, and 82%, respectively. Survival rates were 92%, 76%, and 34% at 1, 2, and 5 years.

Conclusions:

• Cryopreserved arterial allografts provide acceptable secondary patency for distal bypasses in CLI.
• These allografts are a suitable alternative for limb salvage when venous conduits are absent.
• The use of arterial allografts can potentially improve limb salvage and quality of life in select CLI patients.