Biodegradation of glutaraldehyde-tanned human umbilical vein grafts

A retrospective analysis of the long-term behavior of 111 glutaraldehyde-tanned human umbilical vein (HUV) grafts implanted between September 1977 and December 1993 was conducted. A total of 81 patients, with a mean age of 68.7 years, received the grafts and were followed up for between 1 and 131 months. The 5-year primary cumulative patency rate for above-knee femoropopliteal bypass was 83.1%, whereas that of other bypasses was 60.9%. An aneurysm of the graft was defined as a physically apparent localized dilatation, with diffuse ectasia being excluded. There were 11 aneurysms found in 9 grafts, 2 of which arose at the factory-made suture lines. The accumulated incidence of aneurysms had reached 21.9% by the 6th year. One aneurysm compressed the graft and resulted in limb-threatening ischemia and another resulted in frank rupture. Moreover, reinforcement of the mesh could not prevent aneurysm development, the repair of which is mandatory due to the risk of rupture and acute thrombosis. The HUV grafts showed an acceptable patency rate in the above-knee location, but the incidence of aneurysm formation after 5 years was abnormally high. Thus, both the risks and benefits of HUV grafts must be taken into account when considering their clinical application.