The second decade of experience with the umbilical vein graft for lower-limb revascularization.

Some 20 years have elapsed since the initial concept and development of the human umbilical vein graft. Experience with 1074 umbilical vein grafts forms the basis of this report as the indications for this prosthesis have been refined and its performance defined. In 1988, the author and colleagues published their 10-year experience with umbilical vein which described the results of 907 bypasses constructed in 715 patients (799 limbs). Over the past 5 years, the use of umbilical vein has decreased because of a commitment to autologous saphenous vein. A total of 167 additional umbilical vein bypasses were performed at Englewood Hospital and Medical Center between 1985 and June 1993. Secondary patency rates for popliteal and crural reconstructions at 5 years showed a trend of continuous improvement--65% and 45% respectively compared with 57% and 33% as reported during the first decade of experience. Rates of infection, stenosis and pseudoaneurysm decreased and only two aneurysms have been discovered during this period. Umbilical vein is an acceptable alternative to the absent or deficient autologous vein. Patency rates are second only to autologous vein rates and the fear of failure due to aneurysm formation has not only been overstated, but also significantly exaggerated.