Snyder S O, Wheeler J R, Gregory R T, Gayle R G, Zirkle P K
Surgery. 1987 Mar;101(3):283-91.
Six patients with patent multilevel prosthetic grafts (three axillofemoral-femoral grafts, an aortobifemoral graft, an axillofemoral and femoral-anterior tibial graft, and an axillofemoral and femoral-popliteal graft) that demonstrated overt infection involving both the proximal inflow (one infrarenal aorta, five axillary arteries) and groin anastomoses required complete graft excision. Cadaveric inferior vena cava, common and external iliac, common and superficial femoral, and greater saphenous veins were harvested in conjunction with multiple organ donor procedures. Identical anatomic reconstruction within the infected fields was accomplished, with patency and distal perfusion maintained for intervals sufficient to achieve complete resolution of infection in all cases. This interval of revascularization with a venous homograft has served as a temporizing maneuver, which permitted eradication of infection and allowed subsequent reimplantation of prosthetic graft material without associated reinfection in the two instances in which it was required. Use of freshly harvested large-caliber caval, iliac, and femoral homograft veins as arterial substitutes in infected fields has not been previously reported. Case histories and a review of the venous homografting literature are included.
6例多级人工血管通畅但出现明显感染的患者（3例腋股-股人工血管、1例主双股人工血管、1例腋股及股-胫前人工血管、1例腋股及股-腘人工血管），其近端流入道（1例肾下腹主动脉、5例腋动脉）和腹股沟吻合口均有感染，需要完整切除人工血管。在多器官捐献手术中获取尸体的下腔静脉、髂总静脉和外静脉、股总静脉和浅静脉以及大隐静脉。在感染区域内完成相同的解剖重建，在所有病例中均维持通畅和远端灌注足够长的时间以实现感染的完全消退。使用静脉同种异体移植物进行血管再通的这段时间起到了临时处理的作用，在需要的两例中，这使得感染得以根除，并允许随后重新植入人工血管材料而无相关的再感染。此前尚未有在感染区域使用新鲜获取的大口径腔静脉、髂静脉和股静脉同种异体移植物作为动脉替代物的报道。本文包含病例史及静脉同种异体移植文献综述。
