The Cryopreserved Femoral Artery Homograft Should Be Considered In Patients With Critical Lower Limb Ischemia And No Suitable Autogenous Vein Conduit For Infragenicular Revascularization.

Objectives: Infragenicular revascularization in patients without a suitable autogenous vein conduit remains a challenge. Synthetic grafts and saphenous vein homografts have been used in this setting with limited results. Although cryopreserved femoral artery homografts (FAH) are commercially available in the USA, there are no large published series on their outcome. The purpose of this study was to compare the performance of FAH to the autogenous saphenous vein grafts (SVG) for infragenicular lower extremity bypass.
Methods: Since July 2003, we used commercially available ABO type-specific cryopreserved FAH for infragenicular revascularization in 12 patients (13 limbs), without systemic immunosuppression. Twelve other patients who had undergone infragenicular bypass using the SVG during the same period were randomly chosen as controls (13 limbs). Revascularization was performed for critical ischemia in all limbs.
Results: Overall 30-day survival was 100%. Mean follow-up was 16 months. The mean age was 63 years (range: 45-85). There were 12/24 women (50%). More patients in the FAH group had previous infrainguinal bypasses in the index limb than SVG (10/13 versus 1/13, respectively, p <0.002). We found no significant differences in graft patency (figure 1) or limb-salvage rates (p=ns, by Kaplan-Meier analysis).
Conclusions: Our study shows that FAH can be used for infragenicular bypasses with results comparable to SVG. The cryopreserved femoral artery homograft should be considered when there is no suitable autogenous vein conduit for infragenicular revascularization.