Reoperation for complications of stabilized human umbilical vein grafts

Article Abstract:

Patients who have peripheral vascular disease with limb-threatening ischemia (inadequate blood supply to the foot and leg) or severe claudication (weakness and cramps of the leg) may undergo femoropopliteal bypass graft. This procedure removes the occluded portion of the vessel in the groin or thigh area and replaces it with a segment of vein (usually the saphenous) or a prosthetic graft. Femoropopliteal grafts have a significant incidence of early and late graft failure (occlusion); when this occurs, reoperation is difficult. The umbilical vein may be used when the saphenous vein is either absent or inadequate or when it is important to shorten the time of operation and anesthesia. A study was undertaken of 211 femoropopliteal bypass grafts (177 patients) using stabilized human umbilical vein performed between 1977 and 1986. Within 30 days of operation, 17 patients had graft failure due to thrombosis (clot formation); 14 (83 percent) were successfully treated with reoperation. There were 28 late graft closures, of which 17 (61 percent) were treated with thrombectomy, while four patients (14 percent) had the graft replaced or revised. Aneurysms (localized vessel wall thinning) occurred in 3 percent of grafts at risk; the incidence of graft infection was also 3 percent. Reconstruction was successful in six of seven cases of aneurysm; graft infection necessitated amputation in six of seven cases. These results illustrate the ability of the stabilized human umbilical vein to successfully undergo thrombectomy (clot removal) without damage. It should be noted that when adequate the saphenous vein is available it is a superior graft material. (Consumer Summary produced by Reliance Medical Information, Inc.)

Umbilical cord, Graft occlusion, Vascular, Vascular graft occlusion

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Effect of a failed distal reconstruction on the level of amputation

Article Abstract:

Unsuccessful attempts at revascularization, performed to reestablish the blood supply to an extremity, may hinder healing and cause any subsequent amputation to be more extensive than would otherwise be necessary. But this assumption has been challenged in recent years. A study was undertaken of patients undergoing leg amputation during an 18-year period. There were 210 amputations (in 191 patients) performed following failed attempts at vascular reconstruction. These amputations were compared with 551 amputations (433 patients) in limbs with no prior revascularization surgery. All amputations were performed for advanced ischemia, which is decreased blood supply to an organ or body part, often characterized by pain and dysfunction of the region. The average patient age was 69 years. Associated risk factors were diabetes (48 percent of patients), hypertension (41 percent), and smoking (24 percent). Symptoms prior to amputation were either pain at rest or pain at rest with tissue death. Of 143 below-the-knee amputations performed on patients who had failed revascularization (bypass or graft failure), 110 (77 percent) eventually healed. This is in contrast to an eventual healing rate of 89 percent (266 of 289) in patients who had not had prior revascularization. This was a statistically significant difference in healing rate. It is recommended that vascular reconstruction should be attempted when indicated. However, it must be realized that this may influence the level of a subsequent amputation in a leg being considered for below-knee amputation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Peripheral vascular diseases, Amputation, Amputations of leg, Leg amputation

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