Experimental and clinical use of human umbilical cord vessels as vascular substitutes

The vessels of the human umbilical cord possess several unique attributes that made make important for their potential use as vascular substitutes. They are readily available in terms of source, are valveless, and individually of uniform diameter. They can be prepared for use as straight or tapered prosthesis up to lengths of several feet and over a wide range of diameters ranging from 1 to 12 millimeters. Most important, their effectiveness to function as vascular substitutes has been demonstrated experimentally in the baboon and more recently in humans. The latter consists of a series of patients requiring vascular reconstruction of the lower extremity who were otherwise faced with potential limb loss and in whom other graft materials were either unavailable or unsuitable. This included bypasses to the tibial and peroneal arteries as well as to the popliteal artery. Serial postoperative angiography was performed to demonstrate patency and the absence of aneurysms. Despite the advanced degree of occlusive disease in these patients, single vessel runoff being the predominant angiographic pattern, highly satisfactory patency rates were achieved. The potential for modified umbilical vessels to function as vascular substitutes is very promising and represents an important addition to the armamentarium of all vascular surgeons.