Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement.
Vascular complications are major causes of graft failure in liver transplantation. The use of different vascular grafts is common but the results are controversial. The aim of this study was to create an 'ideal' arterial interponate for vascular replacements in the clinical field. An autologous, tubular graft prepared from the posterior rectus fascia sheath was used for iliac artery replacement in dogs for 1, 3, 6 and 12 months. Forty-one grafts were implanted and immunosuppression was used in separate groups. The patency rate was followed by Doppler ultrasound. Thirty-seven grafts remained patent, 2 cases with thrombosis and 2 cases with stenosis occurred. There was no evidence of necrosis or aneurysmatic formation. The histological analysis included conventional light microscopic and immunohistochemical examinations for CD34 and factor VIII. The explanted grafts showed signs of arterialisation, appearance of elastin fibres, and smooth muscle cells after 6 months. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. In conclusion, the autologous graft presents acceptable long-term patency rate. It is easy to handle and the concept of beneficial presence of the anti-clot mesothelium until endothelialisation seems to work. The first clinical use was already reported by our group with more than 2 years survival.
Kóbori
László
L
Transplantation and Surgical Department, Semmelweis University, H-1082 Budapest, Baross u. 23-25, Hungary. kobori@trans.sote.hu
Németh
Tibor
T
Nagy
Péter
P
Dallos
Gábor
G
Sótonyi
Péter
P
Fehérvári
Imre
I
Nemes
Balázs
B
Görög
Dénes
D
Patonai
Attila
A
Monostory
Katalin
K
Doros
Attila
A
Sárváry
Eniko
E
Fazakas
János
J
Gerlei
Zsuzsanna
Z
Benko
Tamás
T
Piros
László
L
Járay
Jeno
J
De Jong
Koert P
KP
D000818:Animals; D004285:Dogs; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000517:prevention & control; D007083:Iliac Artery / Q000637:transplantation*; D007165:Immunosuppression Therapy; D016031:Liver Transplantation; D014463:Ultrasonography; D014654:Vascular Patency / Q000502:physiology*