Fresh Arterial Homograft Transplantation: A Novel Concept for Critical Limb Ischaemia

AbstractIntroduction: homografts have been used since the early days of vascular surgery, but have failed to provide long-term success. Arteries supplying organ transplants seldom show signs of biodegradation. We therefore introduced fresh arterial homograft repair with consecutive immunosupression (ATX).Aim: to assess feasibility and clinical usefulness of ATXSetting: university teaching hospital.Material and Method: conduits were harvested during multi-organ procurement and stored in Custodiol®. Implantation followed immediately. Viability of the transplant was documented in all cases. Patients received immunosuppession for the duration of bypass function.Results: thirteen patients received ATX for critical limb ischaemia (M/F: 11/2, age: 62yr, previous revascularisations: 4.5 (1–8), median run-off index 5, previous organ transplant: n=2. Most bypasses were anastomosed to single tibial or pedal vessels. There was no early failure. Within an average follow up of 12 months there were 6 graft thromboses in 5 patients, successfully revised in 4. Three limbs were lost after 2, 5 and 6 months due to graft failure. Graft rejection was shown in 1 out of 3 explanted grafts.Concusion: we report a concept, which may circumvent the problem of biologic graft degeneration. Limb salvage was possible in 75% at 12 months in otherwise difficult circumstances