RESUMO
OBJECTIVE: Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. MATERIAL AND METHODS: A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). RESULTS: The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. CONCLUSION: This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.
Assuntos
Doenças da Aorta/cirurgia , Artérias/transplante , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Criopreservação , Fístula Intestinal/etiologia , Infecções Relacionadas à Prótese/cirurgia , Fístula Vascular/cirurgia , Aloenxertos , Antibacterianos/uso terapêutico , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Doenças da Aorta/mortalidade , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Remoção de Dispositivo , Sobrevivência de Enxerto , Mortalidade Hospitalar , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/mortalidade , Fístula Intestinal/cirurgia , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/mortalidade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/mortalidadeRESUMO
The authors recently observed two patients who suffered acute lower limb ischemia secondary to thrombosis of a small (diameter of less than 2 cm) popliteal artery aneurysm. A literature search lead to the conclusion that small popliteal aneurysms, covered with mural thrombus and presenting a distorted neck due to elongation, are prone to thrombosis. Another risk factor is a restrained outflow bed as a result of previous micro-embolisations into the tibial arteries. The authors conclude that small popliteal artery aneurysms are not so innocent as is often presumed.