[Preserved human umbilical cord vessel as a small caliber vascular substitute: experimental and clinical study]

The author has studied glutaraldehyde stabilized human umbilical cord vessels (PHUV) both experimentally and clinically since Nov. 1976. The experimental findings showed that the PHUV is not organized and its patency depends on the blood compatibility of the fibrin net and blood flow. The histologic examination of the graft wall revealed a slight inflammatory response consisting of macrophages and occasional foreign body giant cells around the Dacron mesh but with very little reaction in the umbilical vein itself. Clinically, 72 reconstructions using Biografts were performed in 52 cases with peripheral arterial occlusions. These consisted of 14 femoropopliteal (FP) bypasses above the knee, 26 below the knee, 10 femorotibial or peroneal and 16 other miscellaneous procedures including aorto-femoral and extra-anatomic bypasses. The cumulative patency rate at 5 years was 63.0% for the total group, 62.9% for the F-P group and 20% for the femoro-tibial or peroneal group. Early failure was thought to be related to technical factors in most instances. The majority of the late failures were due to intimal hyperplasia at the anastomotic sites. Although it is reasonable to employ a Biograft at the popliteal level because of the encouraging results in its clinical use, it is important to study the mechanism of the intimal hyperplasia at the anastomotic sites in order to attain excellent long term results.