Bossi Matteo, Tozzi Matteo, Franchin Marco, Ferraro Stefania, Rivolta Nicola, Ferrario Massimo, Guttadauro Chiara, Castelli Patrizio, Piffaretti Gabriele
Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Ann Vasc Dis. 2017 Dec 25;10(4):391-397. doi: 10.3400/avd.oa.17-00068.
: This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. : This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year. : We treated 21 patients (90% men, n=19) with the mean age of 71±12 years and mean interval between the initial operation and replacement with CHA of 30 months [range, 1-216; interquartile range (IQR), 2-36]. In-hospital mortality was 14% (n=3); no CHA-related complication led to death. Limb salvage was 100%. No patient was lost at the median follow-up of 14 months (range, 2-61; IQR, 6-39). No rupture, aneurysmal degeneration, or re-infection occurred. Estimated freedom from CHA-related adverse events (95% confidence interval, 43-63) was 95% at 3 years. : In our experience, CHAs are a viable option for prosthetic graft infections and provide satisfactory clinical results and favorable stability because of a very low rate of CHA-related adverse events during follow-up.
本研究旨在呈现使用低温保存的人同种异体移植物（CHAs）进行主动脉和周围感染人工血管移植物血管重建的病例。这是一项单中心、观察性描述性研究，并进行回顾性分析。在所有病例中，感染的人工血管移植物材料均被彻底清除。出院时，给予患者抗凝剂。随访检查包括治疗后30天内以及3、6和12个月时的临床就诊、彩色多普勒超声或计算机断层血管造影，之后每年两次。我们治疗了21例患者（男性占90%，n = 19），平均年龄为71±12岁，初次手术与使用CHAs进行置换之间的平均间隔为30个月[范围，1 - 216；四分位间距（IQR），2 - 36]。住院死亡率为14%（n = 3）；没有与CHAs相关的并发症导致死亡。肢体挽救率为100%。在14个月的中位随访期（范围，2 - 61；IQR，6 - 39）内没有患者失访。没有发生破裂、动脉瘤样退变或再次感染。3年时与CHAs相关不良事件的估计无事件生存率（95%置信区间，43 - 63）为95%。根据我们的经验，CHAs是人工血管移植物感染的一种可行选择，并且由于随访期间与CHAs相关的不良事件发生率非常低，能提供令人满意的临床结果和良好的稳定性。
