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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2003 December;10(4):333-46
language: English, Italian
Arterial allograft reconstruction in infected vascular prosthetic grafts. Review of our series in the light of a compatibility study
Odero A. 1, Pirrelli S. 1, Arici V. 1, Piccolo G. 2, Guarino A. 3, Klersy C. 4
1 Vascular Surgery Chair. University of Pavia IRCCS San Matteo Polyclinic, Pavia, Italy
2 North Italian Transplant, Milan Polyclinic, Milan, Italy
3 Italian Allograft Bank Monzino Cardiology Centre, Milan, Italy
4 Biometrics and Clinical Epidemiology Service IRCCS San Matteo Polyclinic, Pavia, Italy
Background. The use of arterial allograft is now a widespread therapeutic alternative in infected vascular prosthetic grafts and mycotic aneurysms. Our series is analysed in function of some factors possibly linked to the development of allograft-correlated complications.
Methods. Between December 1994 and March 2002, 23 patients with infected vascular prosthetic graft were treated at the Vascular Surgery Clinic, University of Pavia, IRCCS San Matteo Polyclinic. The patients were subjected to surgical removal of the infected prosthetic graft and in situ revascularisation through homologous arterial graft. Mean follow-up was 27.2 month (range 40 days-77.4 months).
Results. In 2 cases it was impossible to implant the allograft: 1 for intraoperative decease of the patient, 1 for intraoperative rupture of the allograft. Overall mortality was 34.7%; the amputation rate was 13%. In 34.6% of cases no microorganism was isolated on culturing the explanted prosthetic graft. The rate of perioperative allograft-correlated complications was 30.5%, with mean onset at 6 days. The rate of late allograft-correlated complications was 39%, with mean onset at 25.9 months. No significant association was found between AB0 compatibility and development of allograft-correlated complications. A significant association was detected between lower risk of developing early complications and age of donor above 40 years.
Conclusions. Among factors influencing the development of allograft-correlated complications, age of donor below 40 years and history of drug allergies were found to be associated with a higher risk of allograft-correlated complications.