Critical limb ischaemia: l'utilizzo della vena ombelicale umana criopreservata negli interventi di rivascolarizzazione periferica.

BACKGROUND: Glutaraldehyde stabilized human umbilical veins (HUV) have been used for infrainguinal arterial reconstruction for almost three decades. In our experience primary patency, secondary patency and limb salvage was rispectively 39,9%, 58,5% and 61,5% at 4 years, not signicatively were post-operative thrombosis and aneurysm evolution. Experience with cryopreserved (cHUV) is limited and only few studies specifically investigated its feasibility for bypass grafting. The aim of the study is to establish primary and secondary graft patency as well as limb savage in a single center consecutive series of bypasses grafting with cHUV. METHODS: Between September 2008 and January 2012, 50 patients underwent lower limbs revascularization procedures by using cHUV coated with a Dacron mesh at the operating table. Indications for revascularization with cHUV were: critical limb ischaemia, rest pain, small ulcers and gangrene when autologous saphenous vein was absent. Distal anastomosis was performed in 94% of cases below the knee (33 on popliteal artery, 6 on tibial arteries, 8 on peroneal artery). An artero-venous fistula was performed in 54% of the patients and in 70% of cases the bypass grafting was a redo surgery. All the bypasses performed were reviewed for primary and secondary graft patency as well as limb salvage. RESULTS: Mean population age was 73,3±7,3 with higher prevalence of male (66%) and 46% of diabetic patients. Primary patency was 83% and 78%, after 1 and 2 years respectively. Secondary patency was 82% and 77%, after 1 and 2 years respectively. Limb salvage rate was 86% and 77% after 1 and 2 years. Early graft thrombosis was observed in one patient. We did not observe aneurismal cHUV graft degeneration. CONCLUSIONS: use of cryopreserved HUV provides acceptable patency and limb savage rates representing a valuable alternative for bypass grafting in critical lower limb ischemia.