[Cryopreserved homografts in arterial reconstructions].
The use of cryopreserved homologous vessels (CHV) in arterial reconstructions is indicated in cases when no suitable autologous material is available and the use of prosthetic grafts is contraindicated. In the presentations authors overview their 4 years' experiences with homografts in case of aneurysms and lower limb obliterative arterial disease. Forty four CHV grafts were implanted in 41 patients from May 1997 to May 2001. Following explantation and preparation the grafts are treated in a special preservation solution containing 10% DMSO, antibiotic and antimycotic drugs. Using a cryostat the graft packages get deep frozen and are stored in fluid nitrogen, therefore these grafts are available even after years. Donor and patient data are recorded and processed following strict bacteriological examination. No postoperative immunosuppression therapy was administered. Twenty six greater saphenous veins, 12 superficial femoral arteries, 2 iliac arteries, 3 aortic bifurcations and one thoracic aorta segment were used as graft material--24 grafts were implanted in femoro-crural, 7 in distal femoro-popliteal, 2 in proximal femoro-popliteal, 2 in ilio-femoral, 2 in femoro-femoral crossover, one in aorto-femoral, 3 in bifemoral and one in aorto-aortic position. Successful redo surgery was performed in case of graft occlusion in 6 cases, 11 limbs were amputated because of failed thrombectomy. One patient underwent surgery due to a pseudoaneurysm at the diaphysis of a femoro-crural graft, this case is presented in details. The three year graft and limb patency were 23% and 64% subsequently following infrainguinal reconstructions, graft reocclusion occurred in 17 cases, 11 limbs were amputated. Eight patients died in 30 days following CHV implantations, the causes of death were septic bleeding in 4 cases, acute myocardial infarction in 2 cases and cardiorespiratory insufficiency in 2 cases. According to the authors' results and to the literature based on well defined indication use of cryopreserved homologues vessels are a good choice for vascular reconstruction in cases, when implantation of biologic material is essential for restoring circulation.
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Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68. birgab@kkt.sote.hu
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D000368:Aged; D001011:Aorta / Q000637:transplantation; D001158:Arteries / Q000601:surgery* / Q000637:transplantation; D015925:Cryopreservation; D005260:Female; D005263:Femoral Artery / Q000601:surgery / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000601:surgery / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery / Q000637:transplantation; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*