Three-year experience with glutaraldehyde-stabilized umbilical vein for limb salvage

Abstract

Summary: During the past 3 years, 361 vascular reconstructions were performed employing glutaraldehyde-stabilized umbilical veins. The distal anastomosis terminated at the popliteal segment (n = 183), at either of the tibial arteries (n = 108) or at the peroneal artery (n = 70). One hundred and forty-one (77 per cent) of the popliteal reconstructions were below the knee. Many of the patients undergoing these bypasses had a previous failed reconstruction and were operated upon for limb salvage. Operative mortality rates for the popliteal, tibial and peroneal reconstructions were 2·7, 2·8 and 4·3 per cent respectively. Cumulative graft patency rates at 36 months for each of the three types of reconstruction were 76·4 per cent (popliteal), 63·4 per cent (tibial) and 39·8 per cent (peroneal). Failures were usually due to inappropriate case selection or progressive disease, particularly in the distal circulation. Two grafts were removed because of wound and secondary graft infection. There were no instances of biodegradation, either by aneurysm formation or by myointimal proliferation. These data confirm that attempts at revascularization are definitely preferable to amputation. The use of the glutaraldehyde-stabilized umbilical vein has facilitated the performance of these operations. In appropriately selected cases and with expert surgical technique, long term graft function with limb salvage can be obtained.