Arterial homografts--a possible solution to an infective dilemma.
Seven patients with infected arterial conduits (six with prosthetic bypass grafts and one autogenous vein anastomosis) with ten limbs at risk (three patients with bilateral groin infection) are reported. The most common site for infection was the groin and the most frequent organism cultured was Staphylococcus aureus. These patients were selected for arterial homograft implantation through infected fields as they were unsuitable for extra-anatomical prosthetic bypass or had inadequate autogenous tissue available for use as a bypass conduit, i.e. the alternative to homograft insertion was arterial ligation and potential limb sacrifice. The arterial homografts were obtained form brain-dead organ donors (human immunodeficiency virus, hepatitis B- and hepatitis C-negative) and stored at -80 degrees C until ready for use. All seven patients had initial success with their homograft procedures in terms of graft patency, limb salvage and control of infection, although two required early reoperation for haemorrhage. During the follow-up period (mean 24.5, range 6-52 months) three homografts have occluded at 6, 13 and 29 months resulting in limb loss. Two patients have died at 48 and 52 months from causes unrelated to their homograft procedures with functioning homografts and limb salvage. Two further patients remain alive with patent homografts at 7 and 20 months. The authors' experience suggests that arterial homografts have a role in overcoming arterial bypass infection, achieving wound healing and maintaining limb viability rather than resorting to arterial ligation and accepting major limb amputation.
Wagstaff
S A
SA
Vascular Surgical Unit, Alfred Hospital, Camberwell, Victoria, Australia.
Grigg
M J
MJ
D000671:Amputation, Surgical; D001158:Arteries / Q000601:surgery / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply*; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012306:Risk; D013203:Staphylococcal Infections / Q000601:surgery*; D016896:Treatment Outcome