Cryopreserved Superficial Femoral Artery Allografts for Redo Infrainguinal Bypasses: A Single-Center Experience.

BACKGROUND

Great saphenous vein (GSV) is the ideal conduit for peripheral bypasses. Cryopreserved superficial femoral artery (Cryo-SFA) is an alternative conduit in patients with chronic limb-threatening ischemia (CLTI) who lack suitable autogenous vein. Data on outcomes with Cryo-SFA remain limited. This study aimed to assess the postoperative outcomes and patency of Cryo-SFA for infrainguinal revascularization.

METHODS

A retrospective review of patients undergoing redo infrainguinal bypass with Cryo-SFA between January 2015 and May 2025 was performed at a single institution. All patients had at least one prior failed ipsilateral bypass and no suitable autogenous conduit. Demographics, operative details, and postoperative outcomes were collected. Primary patency was assessed using Kaplan-Meier estimates within 1 year.

RESULTS

A total of 33 patients undergoing infrainguinal bypass using Cryo-SFA were studied. The mean age was 66.7 ± 10 years, and 60.61% (n = 20) were men. Indications included tissue loss (n = 13, 39.4%), ischemic rest pain (n = 10, 30.3%), infection (n = 6, 18.2%), and prior bypass complications (n = 4, 12.1%). Tibial arteries were the most common distal target (n = 20, 60.6%). At 30 days, primary patency was 93.9% (n = 31), with no mortality or major amputations. At the 1-year time end point, 3% mortality was observed. Among surviving patients, 1-year primary patency was 50% (n = 16), primary-assisted patency was 59.4% (n = 19), and secondary patency was 81.3% (n = 26). All patients who lost graft patency ultimately underwent major amputation (n = 6, 18.8%).

CONCLUSION

In this high-risk cohort of patients with CLTI, failed prior revascularization, and limited conduit options, Cryo-SFA demonstrated favorable early outcomes with modest 1-year patency in a high-risk cohort despite frequent tibial targets. Cryo-SFA may serve as a viable salvage conduit for complex infrainguinal revascularization in carefully selected patients.