Ten-years experience using cryopreserved arterial allografts for distal bypass

Introduction - Nowadays, the prevalence of peripheral arterial disease reaches 20%, especially in our ageing population. In long occlusions, the treatment of choice remains the venous distal bypass. However, the number of patients who have already been operated and/or in whom no veins are available is continuously growing. Is has been shown that distal prosthetic bypass is associated with bad outcomes in term of patency but also limb salvage and others solutions have to be proposed in this situation. The aim of this study is to report our 10-years experience of distal bypass using arterial cryopreserved allografts. Methods - Retrospective analysis of data retrieved from our Department between January 2006 and December 2015 was done. All consecutive patients with distal bypass with arterial cryopreserved allografts coming from the European Bank in Brussels, Belgium were included. Endpoints were patency rates, postoperative complications and survival rate. Results - During the study period, 47 bypasses have been performed in 43 patients. There were 16 men and 27 women, with a mean age of 77 years old (range 43-94). Indications were critical limb ischemia in 83% of patients, acute ischemia in 15% and popliteal aneurysm in the remaining 2% and 86% (37/43) of patients have already been operated on the same leg. Half of the distal anastomoses were performed on one of the tibial vessels. The mean length of operation was 172 minutes (range 74-407). In the post-operative period, 16 complications occurred (6 occlusion, 4 bleeding and 6 wound dehiscences) and required 14 re-interventions. Among them, there were 4 thrombectomies, 1 overbypass and 2 major amputations. During the mean follow-up of 844 days (range 98-2568), estimates of primary and secondary patency rates at 6, 12, 24 and 48 months were 64%, 50%, 46%, 28% and 84%, 73%, 65 and 45%, respectively. Limb salvage rates at 12, 24 and 60 months were 88%, 88% and 78%. Survival rates at 12, 24 and 60 months were 97%, 78% and 45%. Conclusion - Despite a low rate of primary patency at 2 years, the secondary patency is acceptable and the limb salvage reached almost 90%. This is good considering the complex treated population, whom only 50% survived at 5 years. Considering these results, cryopreserved arterial allografts seem to be a suitable alterative for distal bypass in the absence of venous material. References1.al FF et. Peripheral artery disease: epidemiology and global perspectives. - PubMed - NCBI [Internet]. [cited 2016 Nov 29]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov,SSL+278531582.al PC et. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. - PubMed - NCBI [Internet]. [cited 2016 Nov 29]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov ,SSL+169504273.Moreira CC, Leung AD, Farber A, Rybin D, Doros G, Siracuse JJ, et al. Alternative conduit for infrageniculate bypass in patients with critical limb ischemia. J Vasc Surg. 2016 Jul;64(1):131–139.e1.4.al JR et. Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. - PubMed - NCBI [Internet]. [cited 2017 Feb 10]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov,SSL+233066515.al AM et. Cryopreserved arterial homografts: preliminary results in infrageniculate arterial reconstructions. - PubMed - NCBI [Internet]. [cited 2017 Feb 9]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov,SSL+?term=Cryopreserved+arterial+homografts%3A+preliminary+results+in+infrageniculate+arterial+reconstructions.6.al NJ et. Open arterial revascularization of the critically ischemic foot using arterial homograft. - PubMed - NCBI [Internet]. [cited 2017 Feb 9]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov,SSL+253067917.al AJ et. Long-term results of arterial allograft below-knee bypass grafts for limb salvage: a retrospective multicenter study. - PubMed - NCBI [Internet]. [cited 2017 Feb 9]. Available from: https://crypto.unil.ch/pubmed/,DanaInfo=www.ncbi.nlm.nih.gov,SSL+?term=Long-term+results+of+arterial+allograft+below-knee+bypass+grafts+for+limb+salvage%3A+a+retro-+spective+multicenter+study