Outcomes After Cadaveric Saphenous Vein Bypass for Limb Salvage: A Single Center Experience
Tushar Bajaj1, Jonathan Deitch1, Jonathan Schor1, Saqib Zia2, Kuldeep Singh1.
1Staten Island University Hospital, Staten Island, NY, USA, 2Staten Island University Hospital, Rancho Mirage, CA, USA.
Objective: Cadaveric saphenous vein (CV) conduits are occasionally used for limb salvage in patients without autogenous veins although long term outcome data is scarce. This study was designed to evaluate the outcomes of CV bypass in patients with critical limb ischemia.
Methods: We retrospectively reviewed the charts from 2010-2017 of 25 patients who underwent 30 implants of Cryovein allografts for critical limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, blood loss, and length of hospital stay. Primary outcomes included graft patency, major amputation rates, and death. Secondary outcomes measured included infection rates, myocardial infarctions, and minor amputations. Statistical analysis was performed using Time Series, Kaplan-Meier estimator, and Chi-squared (χ2).
Results: A total of 30 limbs received a Cryovein bypass, 2:1 male to female, and the average age was 68 years. The most common indication for bypass was gangrene (15), ischemia (9), and rest pain (6). Major amputations occurred in 24% of patients, there was no statistical significance between comorbidities, indication for surgery, or type of bypass when comparing patients that underwent an amputation versus non-amputee patients (p>0.05). Death also occurred in 24%. There were no graft infections. There were no myocardial infarctions in the peri-operative period. Minor amputations such as toe or transmetatarsal occurred in 20% of patients. Only 10% were current smokers. The average graft length 64.2cm, and average graft diameter was 3.9mm. Primary patency rates were 81%, 58%, 50%, and 32% at months 1, 3, 6, and 12, respectively. Secondary patency rates were 82%, 63%, 56%, and 41%, respectively. Limb Salvage at 12 months was 68% (Table 1).
Conclusions: Cadaveric saphenous vein allograft may be used as a bypass conduit as an ultimate surgical option before limb amputation. Despite the poor long term patency rates, the acceptable limb salvage rates of Cryovein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.
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