Fresh arterial homograft transplantation: a novel concept for critical limb ischaemia.
BACKGROUND
homografts have been used since the early days of vascular surgery, but have failed to provide long-term success. Arteries supplying organ transplants seldom show signs of biodegradation. We therefore introduced fresh arterial homograft repair with consecutive immunosuppression (ATX).


OBJECTIVE
to assess feasibility and clinical usefulness of ATX.


METHODS
university teaching hospital.


METHODS
conduits were harvested during multi-organ procurement and stored in Custodiol. Implantation followed immediately. Viability of the transplant was documented in all cases. Patients received immunosuppression for the duration of bypass function.


RESULTS
thirteen patients received ATX for critical limb ischaemia (M/F: 11/2, age: 62yr, previous revascularisations: 4.5 (1-8), median run-off index 5, previous organ transplant: n=2. Most bypasses were anastomosed to single tibial or pedal vessels. There was no early failure. Within an average follow up of 12 months there were 6 graft thromboses in 5 patients, successfully revised in 4. Three limbs were lost after 2, 5 and 6 months due to graft failure. Graft rejection was shown in 1 out of 3 explanted grafts.


CONCLUSIONS
we report a concept, which may circumvent the problem of biologic graft degeneration. Limb salvage was possible in 75% at 12 months in otherwise difficult circumstances.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000187:drug effects / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007511:Ischemia / Q000188:drug therapy / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods*; D014654:Vascular Patency / Q000187:drug effects
D007166:Immunosuppressive Agents