Effects of cryopreservation upon vein function in vivo

Area of Science:

• Vascular surgery
• Cryopreservation
• Tissue engineering

Background:

• Allogeneic vein grafts are crucial for bypass surgery when autologous vessels are insufficient.
• Cryopreservation techniques aim to preserve graft viability and function.
• Dimethylsulfoxide (DMSO) is a common cryoprotectant, but its effects on vein grafts are debated.

Purpose of the Study:

• To review experimental and clinical outcomes of allogeneic veins preserved with chondroitin sulfate and DMSO.
• To compare these outcomes with veins preserved using DMSO alone.
• To assess the factors influencing the patency and success of cryopreserved vein grafts.

Main Methods:

• Review of experimental and clinical studies on cryopreserved vein grafts.
• Comparison of grafts preserved with chondroitin sulfate/DMSO versus DMSO alone.
• Analysis of graft patency and limb salvage rates based on surgical technique and graft characteristics.

Main Results:

• Short-term patency for experimental autologous (100%) and allogeneic (70-100%) cryopreserved veins was observed.
• Graft success was linked to "no-touch" procurement, papaverine use, chondroitin sulfate preservation, and recipient therapy.
• Explanted allografts showed temporary loss of endothelial and smooth muscle function, which recovered.
• Clinical outcomes showed higher 1-year patency (68-74%) and limb salvage (94%) with good initial runoff.
• Poor runoff or complex reconstructions led to lower patency (40-44%) and limb salvage (64%).

Conclusions:

• Chondroitin sulfate-preserved veins demonstrate potential for vascular reconstruction.
• Graft success is multifactorial, involving procurement, preservation, and surgical factors.
• Further research with larger cohorts and longer follow-up is needed to validate clinical performance.
• Chondroitin sulfate-preserved veins are currently indicated for coronary or peripheral bypass when autologous options are unavailable.