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Umbilical vein bypass in patients with severe lower limb ischemia: a report of 121 consecutive cases
Insights
Modified human umbilical vein grafts offer a viable alternative for lower limb bypass surgery when autogenous veins are unavailable. These grafts demonstrated acceptable patency rates for limb salvage and severe claudication, supporting their use in complex vascular reconstructions.
Area of Science:
- Vascular Surgery
- Biomaterials in Medicine
- Regenerative Medicine
Background:
- Severe lower limb ischemia often necessitates bypass grafting.
- Saphenous vein availability is a limitation in many patients requiring arterial reconstruction.
- Alternative graft materials are crucial for improving limb salvage rates.
Purpose of the Study:
- To evaluate the efficacy and safety of modified human umbilical vein (Biograft) for femoropopliteal and femorodistal bypass procedures.
- To assess graft patency and limb salvage rates in patients lacking suitable autogenous veins.
- To compare outcomes between grafts used for limb salvage versus those for disabling claudication.
Main Methods:
- A retrospective analysis of 112 patients undergoing 121 bypass procedures using modified human umbilical vein grafts.
- Procedures included femoropopliteal and femorodistal bypasses, with varying distal anastomosis sites.
- Graft patency and limb salvage rates were calculated using the life table method over a mean follow-up of 24 months.
Main Results:
- Overall cumulative patency rates were 67.7% at 1 year, 61.2% at 2 years, and 56.6% at 3-5 years.
- Limb salvage rates were 86% at 1 year and 75.4% at 5 years.
- Graft patency was higher for limb salvage (58.6%) than for claudication (46.5%) and decreased with more distal anastomoses.
Conclusions:
- Modified human umbilical vein grafts are an acceptable alternative for bypass grafting in patients without suitable autogenous saphenous veins.
- The graft demonstrates reasonable long-term patency and high limb salvage rates.
- This biomaterial provides a valuable option for complex lower limb revascularization.
Abstract:
In 112 patients with severe ischemia of the lower limb and without a suitable saphenous vein, 99 femoropopliteal and 22 femorodistal bypass procedures were performed with the modified human umbilical vein (Biograft, Meadox Medicals Inc., Oakland, N.J.). Seventy-eight percent of the operations were performed for limb salvage. In the remaining 22% the indication was severe disabling claudication. Forty-nine percent of the patients had previously undergone arterial reconstruction of the extremity in question. In 36% the distal anastomosis was to the popliteal artery above the knee, in 46% to the popliteal artery below the knee, and in 18% to one of the crural arteries. It was mandatory to perform an additional proximal reconstruction in 38% of the extremities. The observation time ranged from 6 to 60 months, with a mean of 24 months. Two patients died within the first month. The overall cumulative patency rate calculated by the life table method was 67.7% at 1 year, 61.2% at 2 years, and an unchanged 56.6% at 3 to 5 years. The cumulative patency rate in the limb salvage group was higher (58.6%) than the patency rate of the grafts implanted for claudication (46.5%, not significant). Graft patency decreased the more peripherally the distal anastomosis was situated, but we could demonstrate neither a significant relationship between graft patency and runoff nor any prognostic significance in the peroperatively measured flow values. Limb salvage calculated by the life table method was 86% at 1 year and 75.4% at 5 years. It is concluded that the umbilical vein graft is an acceptable alternative for bypass grafting in patients without a suitable autogenous vein.