Comparison of cryopreserved arterial allografts versus heparin-bonded vascular grafts in infragenicular bypass for chronic limb threatening ischemia

Abstract Objectives The purpose of this study was to compare cryopreserved arterial allograft (CAA) to heparin-bonded prostheses (HBP) in infragenicular bypasses for patients with chronic limb-threatening ischemia (CLTI). Methods This retrospective study took place in two university hospitals and included 41 consecutive patients treated for CLTI. In the absence of suitable saphenous vein, an infragenicular bypass was performed using either CAA (24 cases) or HBP (17 cases). Kaplan-Meyer analysis compared primary and secondary patency, and amputation-free survival rates. Binomial logistic regression analyzed risk factors for major amputation and thrombosis. Results The mean follow up was 18.5 months (±14.3) in the CAA group, 17.6 (±6.1) in the HBP group. In the CAA group, primary and secondary patency rates at 12 months were 52% (±10,6) and 61% (±10,3), compared to 88% (±7,8) and 94% (±5,7) in the HBP group, respectively. The difference in patency rates was not statistically different (p=.27 and p=.28, respectively). The statistically significant factors of graft thrombosis were, a stage 4 from the WIfI classification (Wound Ischemia foot Infection) with a six times higher risk (p=.04), and a distal anastomosis on a leg artery with a nine times higher risk of thrombosis (p=.03). Amputation-free survival rates at 18 months were similar between the groups (CCA: 75% (±9) vs. HBP: 94% (±6), p=.11). Patients classified as WIfI stage 4 had 13 times higher odds to undergo major amputation than patients with WIfI stage 2 or 3 (CI 95, 1.16-160,93; p=.04). The intervention was longer in the CCA group of 74 minutes (278min ±86) compared to the HBP group (203min ±69). This difference was statistically significant (CI 95, 17.86 to 132.98), t(35) = 2.671, p =.01. Conclusions CCA are not superior to HBP in infragenicular bypasses for CLTI, and may not be worth the extra cost and the longer operative duration.