Fresh cold-stored vascular allografts in subgenicular location: Our experience with rescue endovascular techniques
Abstract
OBJECTIVE: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality and a 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 7/2005 and 7/2021. RESULT: 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. CONCLUSION: Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results despite 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.