Venous Allografts for Critical Limb Ischaemia

In as many as 25% of the patients with critical lower limb ischaemia, a suitable autogenous vein graft is not available. Patency rate of prosthetic grafts is disappointing at the infrageniculate level. Recently, there is renewed interest in the use of preserved venous allografts as an alternate conduit in patients with threatened ischaemic limbs. From 1991 to 1993, the authors revascularized 12 ischaemic limbs with venous allografts (10 preserved at 4 degrees C, 2 Varivas grafts). The indication for operation was rest pain in five patients and tissue necrosis in seven. Nine patients had one or more previous ipsilateral revascularizations. The at 4 degrees C preserved venous allografts were conserved for a near period of 2 months. In only half (5/10) of the cases ABO isocompatibility could be respected. Distal anastomosis was always below the knee. In 6 patients, the anastomosis was at tibial level. There was one rupture of a Varivas graft on the fifth postoperative day, necessitating ligation of the graft and subsequent amputation. All other grafts remained patent for a mean period of 10.6 months. Actually, 6 grafts are still open. Most patients were given aspirin. Only three patients were under oral coumarin anticoagulation in an effort to prevent early graft failure. The limb salvage rate is 67% (8/12) (mean follow-up of 13 months). The authors discuss the clinical experience with venous allografts as published in recent literature. Use of venous allografts for arterial reconstruction in humans was met with limited success so far. The one year patency approximates 50%. Venous allografts progress in an ineluctable way to a fibrous conduit.(ABSTRACT TRUNCATED AT 250 WORDS)