Lower Extremity Revascularization with the Glutaraldehyde Stabilized Human Umbilical Cord Vein Graft

The introduction of new graft materials for vascular reconstruction has rekindled interest in patency rates and the long-term morphologic changes that occur after implantation. Our experience with glutaraldehyde stabilized umbilical vein grafts has provided an opportunity to examine some long-term clinical implants and derive information based upon prior laboratory evaluations and current clinical experiences. Glutaraldehyde stabilization of the preimplant graft results in retention of the original architecture, including the inner elastic lamina that is responsible for the thromboresistance of the deendothelialized flow surface. Results of siuface energy studies showed that the umbilical vein maintains values in the biocompatible zone, 2.5 ± 0.5 MN • m (25 ± 5 dynes • cm), even after chemical pTxx:essing and implantation. Internal reflection spectroscopy confirms that lipid deposition occurs but is quantitatively related to systemic progression or stability of the atherosclerotic process. Angiography up to four-years postimplantation shows no significant degree of biodegradation, but in some instances, irregularity of the surface is present, perhaps being related to graft lengthening. Aneurysmal deterioration is uncommon. Other changes that occur, such as lipid imbibition, probably reflect the metabolic status of the host more so than the graft itself. Cumulative graft patency and limb salvage rates additionally confum the value of the glutaraldehyde stabilized umbilical vein graft as an alternative to the saphenous vein. Compromise of morphologic and biophysical durability reflects host metabolic factors, surgical technique, and inadequacy or reversal of aldehyde cross-links.