Clinical Experience with Cold-Preservation of Venous and Arterial Allografts. Long-Term Outcomes

Czech version

Authors: I. Matia; M. Adamec; L. Janoušek; K. Lipár; T. Marada; D. Klein; P. Baláž; M. Varga; J. Chlupáč; S. Rokošný
Authors‘ workplace: Klinika transplantační chirurgie, Institut klinické a experimentální medicíny, Praha, přednosta: prof. MUDr. Miloš Adamec, CSc.
Published in: Rozhl. Chir., 2010, roč. 89, č. 1, s. 45-54.
Category: Monothematic special - Original

Overview

Introduction:
Venous and arterial allografts extend the possibilities of peripheral arterial disease as well as vascular prosthesis infections treatment.

Material and methods:
Between 10/1997 and 1/2009 we used 112 allogeneic vessels (30 artieries, 82 veins) in 104 patients. Venous allografts were used for 82 reconstructions in 75 patients (M/F 41/34, aged 41–85 years, median 66 years) with critical limb ischemia and no suitable autogenous venous material.

Arterial allografts were used in 9 patients (M/F 8/1, aged 56–77 years, median 63 years) with aortoiliac prosthetic infections or mycotic abdominal aortic aneurysms and in 20 transplanted patients (M/F 11/9, aged 32–67 years, median 56 years) with aortoiliac atherosclerotic disease.

Results:
Patients survival rate after allovenous bypasses was 92% at 1 year and 78% at 3 years. Limb salvage rate was 67% at 1 year and 53% and 3 years. Secondary patency rate was 48% at 1 year and 27% at 3 years.

Patient survival rate after alloarterial bypasses was 86% at 1 year and 69% at 3 years. No signs of arterial grafts aneurysmal formation and no need for secondary intervention of any arterial reconstruction was observed during the follow up period in any patient after alloarterial transplantation.

Conclusions:
Cold-stored venous and arterial allografts are suitable alternative conduits for limb salvage procedures, vascular prosthesis infections as well as for arterial reconstructions in transplanted patients.

Key words:
venous allograft – arterial allograft – immnosuppression – transplantation – prosthetic infection

Sources

1. Matia, I., Adamec, M., Fronek, J., et al. Ischemia of the large intestine after simultaneous kidney transplantation and aortic replacement with a fresh graft in an abdominal aortic aneurysm. Rozhl. Chir., 2004; 83: 121–127.

2. Carrel, A. Ultimate results of aortic transplantation. J. Exp. Med., 1912; 15: 389–398.

3. Gross, R. E., Bill, A. H., Jr., Peirce, E. C., Jr. Methods for preservation and transplantation of arterial grafts; observations on arterial grafts in dogs; report of transplantation of preserved arterial grafts in nine human cases. Surg. Gynecol. Obstet, 1949; 88: 689–701.

4. Dubost, C., Allary, M., Oeconomos, N. Resection of an aneurysm of the abdominal aorta: Reestablishment of the continuity by a preserved human arterial graft, with result after five months. AMA Arch. Surg., 1952; 64: 405–408.

5. Szilagyi, D. E., Rodriguez, F. J., Smith, R. F. et al. Late fate of arterial allografts. Observations 6 to 15 years after implantation. Arch. Surg., 1970; 101: 721–733.

6. Meade, J. W., Linton, R. R., Darling, R. C., et al. Arterial homografts. A long-term clinical follow-up. Arch. Surg., 1966; 93: 392–399.

7. Bahnini, A., Ruotolo, C., Koskas, F., et al. In situ fresh allograft replacement of an infected aortic prosthetic graft: Eighteen months_ollow-up. J. Vasc. Surg., 1991; 14: 98–102.

8. Kieffer, E., Gomes, D., Chiche, L., et al. Allograft replacement for infrarenal aortic graft infection: Early and late results in 179 patients. J. Vasc. Surg., 2004; 39: 1009–1017.

9. Carpenter, J. P., Tomaszewski, J. E. Human saphenous vein allograft bypass grafts: Immune response. J. Vasc. Surg., 1998; 27: 492–499.

10. Mirelli, M., Stella, A., Faggioli, G. L., et al. Immune response following fresh arterial homograft replacement for aortoiliac graft infection. Eur. J. Vasc. Endovasc. Surg., 1999; 18: 424–429.

11. Lopez-Cepero, M., Sanders, C. E., Buggs, J. et al. Sensitization of renal transplant candidates by cryopreserved cadaveric venous or arterial allografts. Transplantation, 2002; 73: 817–819.

12. Prager, M., Holzenbein, T., Aslim, E., et al. Fresh arterial homograft transplantation: A novel concept for critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg., 2002; 24: 314–321.

13. Adamec, M., Matia, I., Janousek, L., et al. Renal transplantation in patients with abdominal aortic aneurysm – a new surgical approach. Transpl. Int., 2004; 17: 647–650.

14. Matia, I., Adamec, M., Janousek, L., et al. Fresh arterial grafts as conduits for vascular reconstructions in transplanted patients. Eur. J. Vasc. Endovasc. Surg., 2006; 32: 549–556.

15. Matia, I., Janousek, L., Marada, T., et al. Cold-stored venous allografts in the treatment of critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg., 2007; 34: 424–431.

16. Matia, I., Adamec, M., Varga, M., et al. Aortoiliac reconstruction with allograft and kidney transplantation as a one-stage procedure: Long term results. Eur. J. Vasc. Endovasc. Surg., 2008; 35: 353–357.

17. Matia, I., Pirk, J., Lipar, K., et al. Successful surgical treatment of multilevel aortic aneurysms combined with renal transplantation. J. Vasc. Surg., 2009; 50: 198–201.

18. Matia, I., Lodererova, A., Adamec, M. Delayed administration of FK 506 is sufficient to suppress acute rejection changes after aortal transplantation in rats. Transpl. Int., 2007; 20: 371–380.

19. Stadler, P., Sebesta, P., Klika, T., et al. Allografts in the vascular surgery. Rozhl. Chir., 2005; 84: 350–355.