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Cryopreserved Ssphenous Vein Allograft for Infragenicular Bypass in the Presence of Foot Infection
Walaya Methodius Rayford, M D, James M. Combs, M D, Eric D. Wellons, M D, James M. Poindexter, M D, David Rosenthal, M D.
Atlanta Medical Center, Atlanta, GA, USA.

Objectives:
Autologous saphenous vein is the preferred conduit for lower extremity revascularization in the presence of infection. We report our distal bypass experience with cryopreserved saphenous vein allograft (CSVA) in 12 patients in whom autologous vein was not available.
Methods:
Between July 2004 and May 2010, 12 patients with overt foot infections underwent 13 arterial reconstructions with CryoVein® cryopreserved human saphenous vein allograft. The mean age of the cohort was 68.4 years (range 56 to 80 years). Ninety-two percent (92%) of the patients presented with Rutherford Class 5 or 6 disease state which required wide debridement and copious irrigation of all infected tissue beds. Allografts were obtained from CryoLife, Inc®. (Kennesaw, GA).
Results:
Twelve patients underwent 13 infragenicular bypasses with CSVA. Distal anastomosis were performed to the below knee popliteal artery ( 1 ), tibioperoneal trunk ( 6 ), posterior tibial ( 4 ), peroneal ( 1 ) and dosalis pedal artery ( 1 ). Two patients died with patent grafts during follow-up at 9 and 52 days postoperatively for an 83% survival rate. Three grafts failed during follow-up between 1 and 36.3 months (mean 11.7 months). Two of these patients underwent amputation for an 82% limb salvage rate. The primary cumulative and primary assisted patency rate determined by Kaplan-Meier analysis was 40% (SE20%) and 60% (SE 19%) at 18 months follow-up, respectively. No recurrent infections were reported.
Conclusions:
In patients who have complex risk factors and the presence of infection, CSVA appears to be a reasonable option for revascularization when no suitable autologous tissue is available. Further studies are needed to determine the durability of CSVA to salvage limbs in the presence of infection.


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