Long-term behaviour of modified human umbilical vein grafts; late aneurysmal degeneration established by colour-duplex scanning.

ABSTRACT

To define long-term results of modified human umbilical vein (MHUV) grafts a retrospective study was undertaken, and in addition the incidence of aneurysmal degeneration was investigated by Colour-Duplex scanning. From July 1979 until December 1986, 227 MHUV grafts were implanted in 181 patients (204 limbs). The operative indication was claudication in 110 limbs and ischaemic rest pain or gangrene in 94 limbs. The distal anastomosis was at the level of the popliteal artery in 167 limbs and at one of the crural arteries in 37 limbs. During the first month mortality was 3%. Primary and secondary patency rates were calculated for different subgroups. At 5 years the cumulative primary and secondary patency rates for femoro-popliteal grafts were 56 and 64% and for femoro-crural bypasses 19 and 21%. In the retrospective part of this analysis non-occlusive graft-failure occurred in 14 limbs (7%). This was due to infection (7 limbs), aneurysm-formation (4 limbs) or progressive footgangrene (3 limbs). Six of these limbs came to an amputation, however, no amputation was related to aneurysmal degeneration. The amputation-rate was significantly higher in the group with femoro-crural reconstructions as compared to the group with femoro-popliteal reconstructions (32 and 13% respectively; P less than 0.001). From these observations it becomes apparent that the use of MHUV-grafts as femoro-crural bypass is rarely justified. Aneurysmal changes as found by colour-Duplex scanning of 63 limbs with patent grafts at the time of this investigation were present in 23 grafts (37%). The mean internal diameter of the aneurysms was 12.6 mm (range 9.1 to 43.0 mm).(ABSTRACT TRUNCATED AT 250 WORDS)