Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Vasc Surg. 2019 Aug;70(2):562-568. doi: 10.1016/j.jvs.2018.10.111. Epub 2019 Feb 6.
Cryopreserved human arterial allografts are a recognized acceptable alternative for vascular reconstruction when other traditional conduits are either unavailable or contraindicated. We reviewed our experience using cryopreserved arterial allografts for peripheral artery reconstructions in contaminated and infected surgical fields.
A single-center, retrospective review was conducted of 57 patients who underwent a peripheral vascular reconstruction using a cryopreserved arterial allograft from January 2002 through July 2017. Indications for repair included removal of infected prosthetic bypass (n = 29), revascularizations in contaminated fields (n = 11), primary arterial repair in the setting of infection (n = 10), and infected vascular closure devices (n = 7). Aorta-based repairs were excluded. Demographics, index procedural details, postoperative complications, and conduit patency were analyzed. Primary end points included conduit-related mortality and graft failure as measured by reinfection, hemorrhage, or aneurysmal degeneration. Mean follow-up for the study is 27.8 months (range, 2-125 months).
A total of 57 peripheral vascular reconstructions using cryopreserved arterial allografts were performed during the 15-year period. Among the 22 women and 35 men treated, the mean age was 61 years. The vascular beds involved included iliofemoral (n = 39), femoropopliteal or femoral-distal (n = 10), axillosubclavian or brachial (n = 2), mesenteric (n = 3), and carotid (n = 3) arteries. Adjunctive muscle flap coverage of the allograft conduit was performed in the majority of cases (61%; n = 35). The 30-day mortality was 9%; one death was directly related to conduit insertion. The 30-day conduit-related complication rate was 14% and included hemorrhage from the graft requiring return to the operating room (n = 4) and graft infection (n = 4). The late conduit-related complication rate was 15.8% and included graft infection (n = 1), graft thrombosis (n = 3), major amputation resulting from conduit failure (n = 1), pseudoaneurysm degeneration requiring repair (n = 2), graft hemorrhage (n = 1), and symptomatic graft stenosis (n = 1).
A cryopreserved arterial allograft is a useful alternative conduit for peripheral vascular reconstruction in infected or contaminated surgical fields when other autologous or prosthetic conduits are either unavailable or contraindicated. In the immediate postoperative period, these repairs demonstrate acceptable resistance to graft failure and reinfection, particularly in conjunction with adjunctive rotational muscle flap coverage. Late conduit-related complications appear to be infrequent.
当其他传统导管不可用或禁忌时，冷冻保存的同种异体动脉移植物是血管重建的公认可接受的替代方法。我们回顾了我们在受污染和感染的手术部位使用冷冻保存的同种异体动脉移植物进行外周血管重建的经验。
对 2002 年 1 月至 2017 年 7 月期间使用冷冻保存的同种异体动脉移植物进行外周血管重建的 57 例患者进行了单中心回顾性研究。修复的指征包括：移除感染的人造旁路（n=29）、污染区域的血运重建（n=11）、感染情况下的原发性动脉修复（n=10）和感染的血管闭合装置（n=7）。排除基于主动脉的修复。分析了人口统计学、索引手术细节、术后并发症和导管通畅性。主要终点包括导管相关死亡率和再感染、出血或动脉瘤样变性导致的移植物失败。该研究的平均随访时间为 27.8 个月（范围 2-125 个月）。
在 15 年期间，共进行了 57 例冷冻保存的同种异体动脉移植物外周血管重建。在接受治疗的 22 名女性和 35 名男性中，平均年龄为 61 岁。涉及的血管床包括髂股（n=39）、股腘或股远（n=10）、锁骨下或肱动脉（n=2）、肠系膜（n=3）和颈动脉（n=3）。大多数情况下都进行了同种异体移植物管道的附加肌肉瓣覆盖（61%；n=35）。30 天死亡率为 9%；1 例死亡与导管插入直接相关。30 天导管相关并发症发生率为 14%，包括需要返回手术室的移植物出血（n=4）和移植物感染（n=4）。晚期导管相关并发症发生率为 15.8%，包括移植物感染（n=1）、移植物血栓形成（n=3）、因导管失效导致的大截肢（n=1）、需要修复的假性动脉瘤退行性变（n=2）、移植物出血（n=1）和症状性移植物狭窄（n=1）。
当其他自体或假体移植物不可用或禁忌时，冷冻保存的同种异体动脉移植物是感染或污染手术部位外周血管重建的有用替代移植物。在术后早期，这些修复术显示出对移植物失败和再感染的可接受的抵抗力，特别是与辅助旋转肌肉瓣覆盖相结合时。晚期导管相关并发症似乎很少见。
