Composite venous allograft for femoro-pedal bypass grafting in critical limb ischaemia

Abstract Background We report a series of four patients with critical limb ischaemia and lack of autologous conduits, treated with composite (end-to-end anastomosis) allogenic fresh/or cryopreserved saphenous vein bypass grafting. This technique may be necessary in case of femoro-pedal artery bypass grafting, which is an extreme situation if there is shortage in length or inadequate quality of the venous allograft. Such a long reconstruction requires two donor saphenous veins. Case report Four patients were indicated for “I-composite” fresh venous allograft for femoro-pedal bypass grafting. One composite graft occluded 4 months postoperatively, one 21 months postoperatively, two other remained patent with median follow-up 23 months. No amputation was required in any of the patients during the follow-up. Conclusion Midterm patency of the reconstruction may be satisfactory provided that the ABO compatibility, short cold ischaemia time of the graft, adequate immunosuppressive therapy and proper follow-up protocol of the patient after vascular allograft transplantation are observed. Surgeons should keep in mind possibility of this technique mainly in diabetic patients with critical limb ischaemia and occluded crural vessels.