Mural degeneration in the glutaraldehyde-tanned umbilical vein graft: incidence and implications.

After discovering an aneurysm in a glutaraldehyde-tanned umbilical vein (GTUV) graft that resulted in graft thrombosis, we reevaluated all patients from our institution who had GTUV grafts implanted for more than 2 years. Of 60 patients identified, 14 of 15 patients with patent grafts were recalled and had either digital subtraction or standard angiographic studies. Angiographic changes in the grafts were graded on a scale of 0 to 3, from normal (grade 0) to frank aneurysmal degeneration (grade 3). Eight grafts (57%) had frank aneurysmal (grade 3) changes, and three other grafts (21%) had preaneurysmal (grade 2) changes. Only one graft was angiographically normal. GTUV grafts undergo aneurysmal degeneration in a significant percentage of implants. Symptomatic aneurysms have presented with thrombosis and limb-threatening ischemia as well as rupture. GTUV aneurysms should be treated by complete graft resection, as segmental resection of diseased portions of grafts resulted in metachronous aneurysm recurrence. Because of the high incidence of GTUV degeneration, the clinical indications for the use of GTUV grafts should be seriously reevaluated, and we recommend that all patients with patent GTUV grafts for more than 2 years be evaluated for the presence of aneurysmal degeneration.