The banking of arterial allografts in the United kingdom. A technical and clinical review.
The standard graft materials for reconstructive vascular surgery are autologous vessels and synthetic prostheses. However, the clinical results are unsatisfactory when the diameter of the required graft is less than 6 mm and attention has therefore been directed to the possibility of using vascular allografts when autologous conduits are not available. In this review, we consider the evidence that cryopreserved allogeneic vessels might meet this need. Other factors being equal, the literature suggests that arteries will give superior performance to veins when grafted into the arterial circulation. Conventional cryopreservation techniques have been developed and these can provide structurally intact and functional small elastic arteries in animal experiments. We conclude that cryopreservation per se produces only modest injury which may well be recoverable following grafting. However, both experimental and clinical studies suggest that immunological injury is a greater problem. Nevertheless, the general indication is that appropriate risk-benefit analysis in individual cases will justify the clinical use of cryopreserved allograft vessels. Immunosuppression with careful immunological monitoring may be justified in the more desperate clinical situations. Finally we conclude that the existing tissue bank network in the United Kingdom is well placed to provide surgeons with such tissue.