Contemporary Outcomes for Arterial Reconstruction with Non-saphenous vein Cryo-Preserved Conduits.

BACKGROUND/OBJECTIVE

Cryo-preserved (CP) products are utilized during challenging cases when autogenous or prosthetic conduit use is not feasible. Despite decades of experience with cadaveric greater saphenous vein (GSV), there is limited available data regarding the outcomes and patency of other cryopreserved products, specifically, arterial and deep venous grafts. This study was designed to evaluate outcomes of non-GSV CP conduits in patients undergoing urgent, emergent, and elective arterial reconstruction at our institution. We hypothesized that non-GSV CP allografts have adequate patency and outcomes and are therefore a feasible alternative to GSV in settings where autologous graft is unavailable or prosthetic grafts are contraindicated.

METHODS

This study was approved by the Institutional Review Board at our institution. We retrospectively reviewed charts of patients undergoing arterial reconstructions using cryopreserved conduits from 2010-2022. Data collected included demographics, comorbidities, smoking status, indications for surgery, indication for CP conduit use, anatomic reconstruction, urgency of procedure, and blood loss. Time-to-event outcomes included primary and secondary graft patency rates, follow-up amputations, and mortality; other complications included follow-up infection/reinfection and 30-day complications, including return to the operating room and perioperative mortality. Time-to-event analyses were evaluated using product-limit survival estimates.

RESULTS

Out of 96 identified patients receiving CP conduits, 56 patients received non-GSV conduits for 66 arterial reconstructions. The most common type of non-GSV cryo-preserved product used was femoral artery (31 patients), followed by aorto-iliac artery (22), and femoral vein (19), with some patients receiving more than one reconstruction or CP product. Patients were mostly male (75%) with a mean age of 63.1 years and mean body mass index of 26.7. Indications for CP conduit use included infection in 53 patients, hostile environment in 36, contaminated field in 30, tissue coverage concerns in 30, inadequate conduit in 9, patient preference in 1 patient. Notably, multiple patients had more than one indication. Most surgeries (95%) were performed in urgent or emergent settings. Supra-inguinal reconstructions were most common (53%), followed by extra-anatomic bypasses (47%). Thirty-day mortality occurred in 10 patients (19%). Fifteen patients (27%) required return to the OR for indications related to the vascular reconstructions, with 10 (18%) cases being unplanned and 5 (9%) cased planned/staged . Overall survival at 6, 12, and 24 months was 80%, 68%, and 59%, respectively. Primary patency at 6, 12, 24 months was 86%, 70%, and 62%, respectively. Amputation-freedom at 6 months, 12 months, and 24 months were 98%, 95%, and 86%, respectively for non-traumatic indications.

CONCLUSIONS

Non-GSV CP products may be used in complex arterial reconstructions when autogenous or prosthetic options are not feasible or available.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.