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Fresh Cold-Stored Vascular Allografts in Subgenicular Location: Our Experience with Rescue Endovascular Techniques
David Janák1, Karel Novotný1, Radovan Fiala1
1Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
Insights
Fresh cold-stored venous allografts offer a viable option for critical limb ischemia (CLI) revascularization when other methods fail. Rescue endovascular techniques are crucial for maintaining graft patency and improving limb salvage rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Regenerative Medicine
Background:
- Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease, carrying high risks of morbidity, mortality, and amputation.
- Traditional treatment options like autologous grafts, prosthetic bypasses, and endovascular methods may not always be suitable for CLI patients.
- Fresh cold-stored venous allografts present an alternative surgical approach for limb revascularization in complex CLI cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using fresh cold-stored venous allografts for below-the-knee revascularization in patients with CLI.
- To assess the role and success of rescue endovascular techniques in maintaining the patency of allogeneic bypass grafts.
- To determine the long-term patency rates and limb salvage associated with this treatment strategy.
Main Methods:
- A retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts was conducted between July 2005 and July 2021.
- Rescue endovascular techniques were employed to restore and maintain the patency of these allogeneic reconstructions.
- Data on patient demographics, procedure details, graft patency, and limb salvage were collected and analyzed.
Main Results:
- 82 allogeneic revascularizations were performed in 75 patients, with a median age of 68 years.
- Rescue endovascular procedures were performed on 26 bypasses, including 30 acute occlusions and 9 stenotic grafts.
- Success rates for rescue endovascular procedures were statistically significant when the distal anastomosis was to the popliteal artery compared to tibial or pedal beds (P < 0.02).
- Cumulative primary patency rates were 89% at 1 month, 51.9% at 12 months, 24.2% at 3 years, and 9.8% at 5 years.
- Limb salvage rates were 72.6% at 1 year, 53% at 3 years, and 36.5% at 5 years.
Conclusions:
- Fresh cold-stored venous allografts can achieve acceptable results for below-the-knee revascularization in CLI, despite limited long-term patency.
- Rescue endovascular techniques are essential for restoring and maintaining the patency of allogeneic reconstructions, offering a high success rate.
- These combined approaches provide a valuable, often indispensable, alternative for limb salvage in CLI patients when other options are exhausted.
Background:
Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency.
Methods:
A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July 2021.
Results:
We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68 years (49 min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P < 0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1 month, 51.9% after 12 months, 24.2% after 3 years, 9.8% after 5 years. Limb salvage was 72.6% in 1 year, 53% in 3 years, 36.5% in 5 years, respectively.
Conclusions:
Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative.
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