Aorto(ilio)popliteal grafting by the obturator route using the human umbilical vein graft

Over a 5 year period, the human umbilical vein (HUV) graft has been used for 16 aorto(ilio)popliteal reconstructions by the obturator foramen route. 69% of the operations has been performed for multilevel disease with the femoral arteries completely unsuitable for reconstruction. One patient died after operation and one early thrombosis could be repaired by thrombectomy and reconstruction of the distal anastomosis. With a mean follow-up period of 15 months (range 1 to 54 months) there were 2 late occlusions (2 years patency rate 73.3%). Another 2 patients returned with ischemic restpain due to progression of distal disease in the presence of a patent graft. It is concluded that the HUV graft represents a very satisfactory prosthesis for long aorto popliteal reconstruction and that a primary obturator graft is justified in the selected patient with multilevel disease and a very poor profunda femoris connection.