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Odense University Hospital is a major tertiary vascular hospital in Scandinavia, performing approx. 200 aortic repairs annually. This article presents the rationale behind this endeavor and the early outcomes of the initial implantation of locally processed homografts. All patients receiving a homograft were identified from the established homograft biobank database and their medical records were reviewed after obtaining consent. All surgeons in charge of homograft implantations were semi structured interviewed regarding the harvesting procedure, the tools for detecting available homografts, their quality and delivery. The National board of Health approved the biobank fulling the EU Directive of Tissues and Cells after 18 months of preparation. From May 6, 2021, to March 1, 2023, 26 patients had a homograft implantation, with 7 for mycotic aneurysms, 10 for aorto-iliac graft infection, 6 for infra-inguinal graft infection, and 3 for graft infection in thoracic aorta. Six (23%) were emergently performed. Two (7.7%) died within 30 days postoperatively, both following in situ replacement of an infected aortoiliac graft, corresponding to a 20% mortality in this subgroup. The incidence of reinfections was 19.2%; one each in the mycotic aneurysm group, the aortoiliac graft infection group, and the thoracic graft infection group. After 90 days, two patients were diagnosed with aorto-enteric fistula. All involved surgeons could easily identify available suitable homografts, and within 2 h have homografts of acceptable quality and requested dimensions. The establishment of the Danish Cardiovascular Homograft Biobank was straightforward and effectively serves cardiovascular procedures performed 24/7. Additionally, the initial experiences seem comparable to others experiences.
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Due to degeneration, homografts were since the 1950s only used strictly for replacement of complex arterial segments and lesions incl. the aortic valve, replacement of infected arterial prostheses, and vascular access for patients on haemodialysis. During the 1990s, rate-differentiated freezing methods and anti-crystallization agents proved to prevent crystallisation, and more widespread use with expanded indications incl. coronary and lower limb bypasses began justified by promising midterm results. In 2021, the first Scandinavian homograft biobank was founded in Odense in Denmark. This review summarises the history and the experiences from this biobank.
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Criopreservação , Humanos , Aloenxertos , Prótese Vascular/efeitos adversos , DinamarcaRESUMO
Introduction: An aberrant right subclavian artery (ARSA) is an aortic anomaly that, in some cases, can be complicated with Kommerell's diverticulum (KD) at the origin of the ARSA. Progression and rupture of KD are associated with high mortality. Timely intervention is therefore required; however, there are no clinical guidelines for the most suitable intervention. Report: A 50 year old, previously healthy, male patient developed dysphagia. He was diagnosed with an aberrant right subclavian artery and KD. The KD increased in size from 4 - 7 cm within 2 months. He underwent single stage hybrid aortic repair involving an aortic valve replacement, total aortic arch debranchment, two thoracic endovascular aortic repair stents, and subclavian plugs. He developed a stroke during the post-operative period; however, all neurological symptoms had disappeared at 6 months and computed tomography showed no endoleaks and all supraortic vessels were open. Discussion: Literature on KD is limited; therefore, there is no consensus on KD treatment. Increasing awareness of rapidly developing KD will add to current knowledge of the disease. One stage cardiac and non-cardiac surgery was successfully performed with no long term complications.
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Donation after circulatory death (DCD) is practiced in several countries to increase the number of organs for transplantation. This review summarises the key points in a new protocol which will introduce controlled DCD in Denmark as an option in seriously ill patients, in whom death is inevitable and the criteria for brain death is not met. It includes a no touch period of five minutes following circulatory arrest. Rapid procurement or normothermic regional perfusion may be applied depending on the organs to be transplanted. The introduction of DCD requires thorough training of involved health personnel.
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Sistema Cardiovascular , Obtenção de Tecidos e Órgãos , Humanos , Doadores de Tecidos , Preservação de Órgãos/métodos , DinamarcaRESUMO
Since the first kidney transplant was conducted in Denmark in 1964, almost 10,000 transplants have been performed. Graft survival has improved over the past two decades despite the increase in age and comorbidities in both donors and recipients, but organ shortage remains a challenge. The focus of this review is to describe the challenges in kidney transplant and highlight the progress achieved in solving these challenges.
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Transplante de Rim , Obtenção de Tecidos e Órgãos , Transplantes , Humanos , Doadores Vivos , Doadores de Tecidos , Dinamarca/epidemiologia , Sistema de RegistrosRESUMO
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) was introduced in the early 1990s and long-term follow-up studies are warranted in current guidelines. METHODS: Patients undergoing TEVAR were consecutively included from 1999 to 2019. Thoracic aortic disease includes thoracic aortic aneurysms, aortic dissection, traumatic rupture, penetrating aortic ulcer (PAU), and intramural hematoma (IMH). Our prospective database recorded baseline characteristics, endoleak or aneurysm growth, and death. Patients were included at the time of treatment and censored at death or first reintervention depending on the analysis. Primary end point was all-cause death; secondary end point was reintervention. Survival and failure analyses were done using STATA IC 16.0 and truncated at 15 years of follow-up. RESULTS: Two hundred and fifty six patients were included and 63% were men. Their mean age at intervention was 66.2 ± 14.5 years and they were followed for a mean of 5.2 ± 4.5 years. Indications for TEVAR were acute aortic syndrome in 40.6%, chronic aortic disease in 44.5%, and traumatic rupture in 14.8%. Technical success was seen in 94.1% of the operations, and the left subclavian artery was covered in 27.7%. A 30-day mortality rate was 21.2% (22/104) and 1.75% (2/114) (P < 0.001) for urgent and elective patients, respectively. Twelve patients (4.7%) died within 24 hr of treatment. Overall, long-term mortality recorded 112 (43.8%) deaths, 29 patients had reinterventions (11.3 %, 95% confidence interval: 7.7-15.9), and aneurysms accounted for 62.1% of all reinterventions. Twenty four (82.8%) reinterventions occurred within the first 5 years. CONCLUSIONS: This long-term follow-up study shows excess mortality in patients treated for acute aortic syndrome compared to chronic aortic disease, within the first 30 days; this difference diminishes at the end of follow-up. Most endoleaks occur within the first 5 years, although new endoleaks continue to develop decades after in previous endoleak-free patients calling for lifelong surveillance.
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Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Procedimentos Endovasculares , Masculino , Humanos , Feminino , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular , Seguimentos , Procedimentos Endovasculares/efeitos adversos , Resultado do Tratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Endoleak/etiologia , Endoleak/cirurgia , Úlcera/cirurgiaRESUMO
Endovascular repair of ruptured aortic aneurysm (REVAR) has been used worldwide in high volume centres since 1994. Observational studies indicate that this treatment modality is equally as good as or maybe even better than open surgery. Until recently, open surgery was the only treatment option in Denmark, but since 2012 REVAR has been introduced at Odense University Hospital and is now performed around the clock in eligible patients. We present a case report of the first patient in Denmark treated with REVAR and briefly discuss complications, prognosis and cost-effectiveness.
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Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Idoso , Angiografia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Pseudoaneurysms in the femoral artery seldom occur spontaneously. Commonly they occur secondarily to trauma or as a complication to surgery or angiography. This study reports the occurrence of a pseudoaneurysm in the left common femoral artery. The patient, a 54-year-old woman, had undergone leftsided hip replacement five years before and several subsequent operations on the left hip due to dislocation and loose cup. She was admitted with a palpable non-pulsating mass in her left inguinal region and pain and cyanosis in her left lower limb. Ultrasound and angiography showed a pseudoaneurysm with occlusion of the popliteal, the tibial, and the peroneal arteries. The patients was successfully treated with actilysis for 48 hours and subsequent vascular surgery.