The second decade of experience with the umbilical vein graft for lower-limb revascularization

Area of Science:

• Vascular Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• The human umbilical vein graft (HUVSG) has been utilized for vascular reconstructions for approximately two decades.
• Previous studies documented outcomes of 907 bypasses in 715 patients over the first 10 years of its use.
• Recent trends show decreased HUVSG utilization due to a preference for autologous saphenous vein grafts.

Purpose of the Study:

• To refine indications and define the performance of HUVSGs based on extensive clinical experience.
• To evaluate the long-term efficacy and safety of HUVSGs in peripheral arterial reconstructions.
• To compare current outcomes with historical data and address concerns regarding graft failure.

Main Methods:

• Retrospective analysis of 1074 HUVSG procedures performed over a 20-year period.
• Focus on 167 bypasses performed between 1985 and June 1993 at Englewood Hospital and Medical Center.
• Evaluation of secondary patency rates, infection, stenosis, pseudoaneurysm, and aneurysm formation.

Main Results:

• Secondary patency rates at 5 years for popliteal and crural reconstructions improved to 65% and 45%, respectively, compared to earlier results (57% and 33%).
• Incidence of infection, stenosis, and pseudoaneurysm decreased over time.
• Only two aneurysms were identified during the study period, suggesting a lower risk than previously feared.

Conclusions:

• The human umbilical vein graft remains an acceptable alternative for vascular reconstruction when autologous veins are absent or insufficient.
• HUVSG patency rates are second only to autologous vein grafts.
• Concerns regarding aneurysm formation as a cause of graft failure have been significantly overstated.