Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization

R. S. Martin, W. H. Edwards, J. L. Mulherin, William Edwards, J. M. Jenkins, S. J. Hoff, G. Johnson, G. Lambert, J. W. Lord, S. O. Snyder, A. G. Diethelm, J. L. Ochsner, Rutledge, McDonald

    Research output: Contribution to journalArticle

    80 Citations (Scopus)

    Abstract

    Objective: Cryopreserved saphenous vein allografts have been offered as an alternative conduit for bypass in ischemic limbs. The authors examined the efficacy of this conduit for arterial bypass to the distal popliteal and tibial arteries in patients in whom autogenous vein was not available. Summary Background Data: Previous experience with arterial and venous allografts has been unsatisfactory because of aneurysmal degeneration and poor patency. Endothelial loss and host rejection have been suggested as mechanisms of graft failure. Cryopreservation by modern techniques with rate controlled freezing, dimethyl sulfoxide (DMSO), and other cryopreservants, has addressed these issues and rekindled interest in vein allografts. Methods: Over a period of more than 5 years, 115 cryopreserved vein allografts were implanted in 87 limbs to the distal popliteal (14) or tibial (101) arteries. The indication for surgery was rest pain in 56 procedures (49%), gangrene in 36 (31%), claudication in 21 (18%), and replacement of aneurysmal allografts in 2. Follow-up was 1 to 61 months (mean 25 months). Results: There was no significant difference in patency related to site of proximal or distal anastomosis, patency of runoff vessels, use of anticoagulation, age, sex, diabetes, hypertension, smoking, indication, source of graft, or use of multiple segments. Revision was required in six grafts for aneurysmal dilatation. Histologic examination of explanted sections of allografts showed no immune response, and immunosuppressive drugs were not used. Conclusions: Although limb salvage has been satisfactory, long-term patency rates for cryopreserved vein allografts are poor when compared with autogenous vein. The cost of cryopreserved allografts far exceeds that of prosthetic grafts, for which comparable and superior results have been reported. Use of cryopreserved vein allografts should be reserved for situations in which adequate lengths of autogenous vein do not exist and the risk of infection of prosthetic grafts is high.

    Original languageEnglish (US)
    Pages (from-to)664-672
    Number of pages9
    JournalAnnals of surgery
    Volume219
    Issue number6
    DOIs
    StatePublished - Jan 1 1994

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    Saphenous Vein
    Allografts
    Lower Extremity
    Knee
    Veins
    Transplants
    Tibial Arteries
    Extremities
    Popliteal Artery
    Limb Salvage
    Gangrene
    Cryopreservation
    Immunosuppressive Agents
    Dimethyl Sulfoxide
    Freezing
    Dilatation
    Smoking
    Hypertension
    Costs and Cost Analysis
    Pain

    All Science Journal Classification (ASJC) codes

    • Surgery

    Cite this

    Martin, R. S., Edwards, W. H., Mulherin, J. L., Edwards, W., Jenkins, J. M., Hoff, S. J., ... McDonald (1994). Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization. Annals of surgery, 219(6), 664-672. https://doi.org/10.1097/00000658-199406000-00009

    Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization. / Martin, R. S.; Edwards, W. H.; Mulherin, J. L.; Edwards, William; Jenkins, J. M.; Hoff, S. J.; Johnson, G.; Lambert, G.; Lord, J. W.; Snyder, S. O.; Diethelm, A. G.; Ochsner, J. L.; Rutledge; McDonald.

    In: Annals of surgery, Vol. 219, No. 6, 01.01.1994, p. 664-672.

    Research output: Contribution to journalArticle

    Martin, RS, Edwards, WH, Mulherin, JL, Edwards, W, Jenkins, JM, Hoff, SJ, Johnson, G, Lambert, G, Lord, JW, Snyder, SO, Diethelm, AG, Ochsner, JL, Rutledge & McDonald 1994, 'Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization', Annals of surgery, vol. 219, no. 6, pp. 664-672. https://doi.org/10.1097/00000658-199406000-00009
    Martin RS, Edwards WH, Mulherin JL, Edwards W, Jenkins JM, Hoff SJ et al. Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization. Annals of surgery. 1994 Jan 1;219(6):664-672. https://doi.org/10.1097/00000658-199406000-00009
    Martin, R. S. ; Edwards, W. H. ; Mulherin, J. L. ; Edwards, William ; Jenkins, J. M. ; Hoff, S. J. ; Johnson, G. ; Lambert, G. ; Lord, J. W. ; Snyder, S. O. ; Diethelm, A. G. ; Ochsner, J. L. ; Rutledge ; McDonald. / Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization. In: Annals of surgery. 1994 ; Vol. 219, No. 6. pp. 664-672.
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    abstract = "Objective: Cryopreserved saphenous vein allografts have been offered as an alternative conduit for bypass in ischemic limbs. The authors examined the efficacy of this conduit for arterial bypass to the distal popliteal and tibial arteries in patients in whom autogenous vein was not available. Summary Background Data: Previous experience with arterial and venous allografts has been unsatisfactory because of aneurysmal degeneration and poor patency. Endothelial loss and host rejection have been suggested as mechanisms of graft failure. Cryopreservation by modern techniques with rate controlled freezing, dimethyl sulfoxide (DMSO), and other cryopreservants, has addressed these issues and rekindled interest in vein allografts. Methods: Over a period of more than 5 years, 115 cryopreserved vein allografts were implanted in 87 limbs to the distal popliteal (14) or tibial (101) arteries. The indication for surgery was rest pain in 56 procedures (49{\%}), gangrene in 36 (31{\%}), claudication in 21 (18{\%}), and replacement of aneurysmal allografts in 2. Follow-up was 1 to 61 months (mean 25 months). Results: There was no significant difference in patency related to site of proximal or distal anastomosis, patency of runoff vessels, use of anticoagulation, age, sex, diabetes, hypertension, smoking, indication, source of graft, or use of multiple segments. Revision was required in six grafts for aneurysmal dilatation. Histologic examination of explanted sections of allografts showed no immune response, and immunosuppressive drugs were not used. Conclusions: Although limb salvage has been satisfactory, long-term patency rates for cryopreserved vein allografts are poor when compared with autogenous vein. The cost of cryopreserved allografts far exceeds that of prosthetic grafts, for which comparable and superior results have been reported. Use of cryopreserved vein allografts should be reserved for situations in which adequate lengths of autogenous vein do not exist and the risk of infection of prosthetic grafts is high.",
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    T1 - Cryopreserved saphenous vein allografts for below-knee lower extremity revascularization

    AU - Martin, R. S.

    AU - Edwards, W. H.

    AU - Mulherin, J. L.

    AU - Edwards, William

    AU - Jenkins, J. M.

    AU - Hoff, S. J.

    AU - Johnson, G.

    AU - Lambert, G.

    AU - Lord, J. W.

    AU - Snyder, S. O.

    AU - Diethelm, A. G.

    AU - Ochsner, J. L.

    AU - Rutledge,

    AU - McDonald,

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    N2 - Objective: Cryopreserved saphenous vein allografts have been offered as an alternative conduit for bypass in ischemic limbs. The authors examined the efficacy of this conduit for arterial bypass to the distal popliteal and tibial arteries in patients in whom autogenous vein was not available. Summary Background Data: Previous experience with arterial and venous allografts has been unsatisfactory because of aneurysmal degeneration and poor patency. Endothelial loss and host rejection have been suggested as mechanisms of graft failure. Cryopreservation by modern techniques with rate controlled freezing, dimethyl sulfoxide (DMSO), and other cryopreservants, has addressed these issues and rekindled interest in vein allografts. Methods: Over a period of more than 5 years, 115 cryopreserved vein allografts were implanted in 87 limbs to the distal popliteal (14) or tibial (101) arteries. The indication for surgery was rest pain in 56 procedures (49%), gangrene in 36 (31%), claudication in 21 (18%), and replacement of aneurysmal allografts in 2. Follow-up was 1 to 61 months (mean 25 months). Results: There was no significant difference in patency related to site of proximal or distal anastomosis, patency of runoff vessels, use of anticoagulation, age, sex, diabetes, hypertension, smoking, indication, source of graft, or use of multiple segments. Revision was required in six grafts for aneurysmal dilatation. Histologic examination of explanted sections of allografts showed no immune response, and immunosuppressive drugs were not used. Conclusions: Although limb salvage has been satisfactory, long-term patency rates for cryopreserved vein allografts are poor when compared with autogenous vein. The cost of cryopreserved allografts far exceeds that of prosthetic grafts, for which comparable and superior results have been reported. Use of cryopreserved vein allografts should be reserved for situations in which adequate lengths of autogenous vein do not exist and the risk of infection of prosthetic grafts is high.

    AB - Objective: Cryopreserved saphenous vein allografts have been offered as an alternative conduit for bypass in ischemic limbs. The authors examined the efficacy of this conduit for arterial bypass to the distal popliteal and tibial arteries in patients in whom autogenous vein was not available. Summary Background Data: Previous experience with arterial and venous allografts has been unsatisfactory because of aneurysmal degeneration and poor patency. Endothelial loss and host rejection have been suggested as mechanisms of graft failure. Cryopreservation by modern techniques with rate controlled freezing, dimethyl sulfoxide (DMSO), and other cryopreservants, has addressed these issues and rekindled interest in vein allografts. Methods: Over a period of more than 5 years, 115 cryopreserved vein allografts were implanted in 87 limbs to the distal popliteal (14) or tibial (101) arteries. The indication for surgery was rest pain in 56 procedures (49%), gangrene in 36 (31%), claudication in 21 (18%), and replacement of aneurysmal allografts in 2. Follow-up was 1 to 61 months (mean 25 months). Results: There was no significant difference in patency related to site of proximal or distal anastomosis, patency of runoff vessels, use of anticoagulation, age, sex, diabetes, hypertension, smoking, indication, source of graft, or use of multiple segments. Revision was required in six grafts for aneurysmal dilatation. Histologic examination of explanted sections of allografts showed no immune response, and immunosuppressive drugs were not used. Conclusions: Although limb salvage has been satisfactory, long-term patency rates for cryopreserved vein allografts are poor when compared with autogenous vein. The cost of cryopreserved allografts far exceeds that of prosthetic grafts, for which comparable and superior results have been reported. Use of cryopreserved vein allografts should be reserved for situations in which adequate lengths of autogenous vein do not exist and the risk of infection of prosthetic grafts is high.

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