Use of Cryopreserved Arterial Allografts as a Reconstruction Strategy in Peripheral Sarcoma Surgery

Abstract

Background

Complete resection of lower limb soft tissue sarcoma may require vascular resection and reconstruction. While prosthetic grafts and autologous saphenous veins are commonly employed, superior patency has been described for autologous veins. However, their use implies harvesting, mostly on the contralateral limb. Limited data exist on the use of cryopreserved arterial allografts for such vascular replacement.

Methods

We report a retrospective series of 11 patients with locally aggressive extremity sarcomas undergoing 20 vascular resections and reconstructions with cryopreserved arterial allografts over a 5-year period. A total of 10 arteries and 10 veins were reconstructed. The mean tumor length on resected specimen was 15.4 cm, with the thigh being the most frequent site of resection. Six patients required additional osseous reconstruction with mega-implants or bone allograft.

Results

Limb salvage was achieved in 91% of patients. One amputation was necessary because of untreatable infection following fracture of a bone allograft in an irradiated area. The 1-year secondary arterial patency was 78%, with one graft requiring revision due to a mechanical friction on a mega-implant. The 1-year venous patency was 69%.

Conclusion

Our series represents the first homogeneous cohort treated with cryopreserved arterial allografts for vascular reconstruction in sarcoma surgery, showing favorable outcomes despite extensive resection characteristics. Their use avoids contralateral limb morbidity and offers promising patency and limb-salvage outcomes.