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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 December;39(6):735-41

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

The use of arterial allografts in aortic graft infections. A three year experience on eighteen patients

Locati P., Novali C., Socrate A. M., Costantini E., Morlacchi E., Pizzalunga G., Costantini S.

From the Department of Vascular Surgery Busto Arsizio Hospital, Busto Arsizio (Varese), Italy


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Back­ground. We ­describe our expe­ri­ence in the treat­ment of ­aortic ­graft infec­tions by ­replacing ­them ­with arte­rial homo­grafts as sug­gested by the ­good ­results ­recently ­described.
­Methods. ­Between ­March 1994 and ­March 1997 ­eighteen ­patients ­with infec­tions of the aor­tof­e­moral bifur­ca­tion seg­ments ­have ­been ­treated. All ­patients under­went a com­plete explan­ta­tion of the ­infected ­graft and an in ­situ revas­cu­lar­iza­tion ­with arte­rial homo­graft har­vested in mul­ti­organ ­removal. ­Eight seg­ments ­were ­freshly pre­served, 10 ­were cryo­pre­served. Four ­patients ­were oper­ated as emer­gen­cies, of ­which 3 for aor­to-en­teric fis­tulas. All ­others pre­sented a ­serious ­septic ­state.
­Results. ­Three ­patients ­died in the ­early post­op­er­a­tive ­period: one of ­acute infarc­tion and two of homo­graft ­related ­causes. In the ­follow-up ­there was ­only one ­death ­from ­acute infarc­tion, a ­branch occlu­sion and two allo­graft ­enteric fis­tulas suc­cess­fully ­treated by sur­gery. All sur­viving ­patients are sub­mitted to peri­od­ical hae­mod­y­namic and tom­o­graphic con­trol ­with an ­average ­follow-up of 22 ­months (­range 3 ­months to 3 ­years) and ­there has ­been no allo­graft degen­er­a­tion so far.
Con­clu­sions. The use of homo­logue arte­rial allo­grafts has ­shown ­good ­results in the treat­ment of ­serious ­aortic ­graft infec­tions ­resulting in ade­quate periph­eral vas­cu­lar­iza­tion. ­There ­have ­been no sig­nif­i­cant degen­er­a­tions to ­date, ­either in ­fresh or cryo­pre­served allo­grafts.

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