Introduction Femoro-popliteal bypass with autologous vascular graft is a key revascularization
method in chronic limb-threatening ischemia (CLTI). However, the lack of suitable
autologous conduit may occur in 15-45% of the patients, necessitating the implantation
of prosthetic or allogen grafts. Only little data is available on the outcome of allograft
use in CLTI.
Aims Our objective were to evaluate the long term results of infrainguinal allograft
bypass surgery in patients with chronic limb-threatening ischemia (CLTI) and compare
the results of arterial and venous allografts.
Methods Single center, retrospective study analysing the outcomes of infrainguinal
allograft bypass surgery in patients with CLTI between January 2007 and December 2017.
Results During a 11-year period, 134 infrainguinal allograft bypasses were performed
for CLTI [91 males (67.9%)]. Great saphenous vein (GSV) was implanted in 100 cases,
superficial femoral artery (SFA) was implanted in 34 cases. Early postoperative complications
appeared in 16.4% of cases and perioperative mortality (<30 days) was 1.4%. Primary
patency at one, three and five years was 59%, 44% and 41%, respectively, while secondary
patency was 60%, 45% and 41%, respectively. Primary patency of the SFA allografts
was significantly higher than GSV allografts (1 year: SFA: 84% vs. GSV: 51% p = 0,001;
3 years: SFA: 76% vs. GSV: 32% p = 0,001; 5 years: SFA: 71% vs. GSV: 30% p = 0.001).
Both primary and secondary patency of SFA allograft implanted in below-knee position
were significantly higher than GSV bypasses (p = 0.0006; p = 0.0005, respectively).
Limb salvage at one, three and five years following surgery was 74%, 64% and 62%,
respectively. Long-term survival was 53% at 5 years.
Conclusion Allograft implantation is a suitable method for limb salvage in CLTI. The
patency of arterial allograft is better than venous allograft patency, especially
in below-knee position during infrainguinal allograft bypass surgery.
