Homologous Saphenous Vein Research Articles

Usability of cryopreserved homologous great saphenous vein for hepatobiliary-pancreatic surgery and living donor liver transplantation

Usability of cryopreserved homologous great saphenous vein for hepatobiliary-pancreatic surgery and living donor liver transplantation

Eligibility of Circumferential Fence With the Autologous Peritoneal Patch for Venous Reconstruction in Right Lobe Living-Donor Liver Transplant: A Case Control Study.

: Our aim was to evaluate the eligibility of hepatic venous drainage technique using circumferential fence with peritoneal patch graft and saphenous vein graft in right lobe living-donor liver transplant. Between November 2007 and December 2017, our center performed 1413 rightlobe living-donor liver transplants. A circumferential fence was created using the peritoneal patch graft for venous drainage reconstruction in 31 of these patients. We compared data of these 31 patients with data of 62 patients who had circumferential fence created with cryopreserved homologous saphenous vein graft (1:2 ratio). Patients with anastomotic stenosis (n = 10) and without anastomotic stenosis (n = 69) were also compared. No statistically significant differences were found between the peritoneal patch graft group and the saphenous vein graft group in terms of clinical parameters, circumferential fence diameter, and postoperative anastomotic stenosis (7.1% vs 26.1%; P = .056). Postoperative anastomotic stenosis developed in 10 patients. No statistically significant differences were found between patients with and without anastomotic stenosis in terms of clinical parameters except for diameter of circumferential fence (P = .001). Diameter of circumferential fence less than 18 mm in patients with and without anastomotic stenosis was shown in 80% and 34.6% of patients, respectively (P = .02). Stenosis-free survival in saphenous vein graft group was significantly better than in the peritoneal patch graft group (P = .023). Our correlation analyses showed a strong correlation between diameter of circumferential fence and the tenosis rate in patients (P = .001). Autologous peritoneal patch graft can be used for creating circumferential fence for hepatic outflow in living-donor liver transplant patients if no better option is available. Despite high anastomotic stenosis rates, peritoneal fencing responded well to radiologic dilatation or stent applications and provided good long-term patency.

Lower limb ischemia after migration of a coronary artery stent into the femoral artery

A coronary stent may be lost in the peripheral or visceral arterial system with an incidence ranging from 0.9 to 8.4%, however, a limb or organ ischemia after stent migration is very uncommon. We report the case of an 83-year-old man who underwent coronary artery stenting at our Hospital's Cardiological Department. During this difficult procedure, due to the critical stenosis of the circumflex artery, the stent was accidentally lost and found at the level of the insertion of the right common femoral on the external iliac artery. After several attempts to rescue the stent through an omolateral and contralateral femoral approach with the hook technique, the right common, superficial and profunda femoral arteries were surgically exposed. The stent was easily removed from the origin of the profunda femoral artery by a longitudinal arteriotomy. Finally, the arteriotomy was closed with a homologous saphenous vein patch. We underline the importance of an early extraction of the stent, discussing the preferable surgical approach to minimize the possible dramatic complications in the peripheral artery system.

Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura

Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov), bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som) e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.

Lessons from 494 permanent accesses in 348 haemodialysis patients older than 65 years of age: 29 years of experience.

Currently, patients older than 65 years of age constitute more than 42% of all new enrolments for dialytic treatment in the USA and Italy. Most of these patients are treated by in-centre haemodialysis (HD), with problems connected to vascular access. Personal experience of 494 new vascular accesses in 348 'difficult' HD-patients older than 65 years over 29 years showed the best results from 221 elbow fistulas in comparison with 32 forearm fistulas (78% vs 57.2% at 3 years; P < 0.05). Among various vascular substitutes, the homologous saphenous vein (HSV) graft, alone or mixed (MX) gave the best secondary patency in comparison with other organic-semiorganic (OSO) or synthetic graft (SYN) angioaccesses with values of 59.4% for HSV, 66.3% for MX, 21.9% for OSO, and 38.6% for SYN grafts, respectively at 3 years.

A Preliminary Experience with the Human Homologous Vein Graft for Vascular Access

In a preliminary study, 38 preserved human homologous saphenous vein grafts were used for secondary vascular access in 36 chronic hemodialysis patients. Cumulative oneyear patency was 67%. Twelve grafts failed, 10 owing to thrombosis and 2 owing to infection. Overall complication rate, morbidity, and patency were compatible with the other available graft materials. A prospective randomized trial of Varivas graft against PTFE has been instigated.

Biological Grafts for Vascular Access in Patients with End-Stage Renal Failure

From 1981 until 1987, 52 vascular accesses were created in patients with end stage renal failure; 392 could be studied retrospectively. Of these, 112 were created by using a biological graft: 88 homologous saphenous vein grafts and 24 bovine heterografts. The overall permeability rate was 94% postoperatively, 62% at 1 year, 45% at 2 and 3 years. There was no statistical difference in the permeability between human saphenous vein grafts and bovine heterografts or between grafts implanted as first access or after failure of an anterior fistula. The main complication observed during the followup was secondary throm bosis, which occurred after an average duration of 8 months. Aneurysms, infec tions, and high flow were very rare. Compared with the results observed with fistulas using the native veins, biological grafts results are poor. Compared with those of other authors 1/m especially for homologous saphenous vein grafts 1/m the authors' results are poor at 1 year and quite good at 2 and 3 years, These data should lead to detection of early stenosis before the end of the first year, especially stenosis of venovenous anastomoses, which are probably responsible for late thrombosis in most cases.

Cryopreserved Homologous Saphenous Vein: Early and Late Patency in Coronary Artery Bypass Surgical Procedures

Autologous saphenous vein has proved to be a satisfactory conduit for use in coronary artery bypass grafting. Unfortunately, it is not always available, and substitute material must sometimes be used. When satisfactory autologous veins were not available and the internal mammary arteries were unsuitable, cryopreserved homologous saphenous veins were used in 28 patients. A total of 76 grafts were constructed. Cryopreserved homologous veins were used for 61 grafts, autologous saphenous veins for 11 grafts, and the internal mammary artery for 2 grafts. Coronary angiography was performed 8 to 12 days postoperatively in 16 patients. Of the 31 homografts studied, 8 were occluded (26%), 3 were stenotic (9%), and 20 were normal (65%). The one internal mammary artery and six autologous veins studied were all patent. Six patients underwent late catheterization 6 to 12 months postoperatively. Thirteen homografts were studied at late catheterization: 11 were occluded, 1 was severely stenotic, and 1 was mildly stenotic. At late catheterization, the one internal mammary artery studied was patent, and the one autologous saphenous vein was 95% occluded. Results of both early and late catheterization performed on 18 patients demonstrated that of the 35 homografts studied, 17 (49%) were occluded, 3 (9%) had greater than 70% stenosis, 1 (3%) had mild disease, and 14 (40%) were free of disease. One year follow-up data obtained on 26 patients revealed that 4 patients (15%) died of cardiac causes, 2 patients (8%) died of noncardiac causes, 11 patients (42%) have recurrent angina, and 9 (35%) are asymptomatic. It is concluded that use of cryopreserved homologous saphenous veins for coronary artery bypass grafting should be avoided if at all possible.

Biogenic grafts in arterial surgery--long-term results (I. The homologous vein--II. The modified heterologous bovine carotid artery--III. The human umbilical vein).

This report summarizes the authors' experience with homologous vein grafts, modified heterologous bovine carotid artery grafts and human umbilical vein grafts in reconstructive vascular surgery. The homologous saphenous vein, taken from living donors, was implanted in 21 patients. The high percentage of early and late complications (28% and 38%, respectively), the difficult availability and the development of modern materials appear to suggest that these grafts, at least the type used in this study, should no longer be employed. The experience with 102 femoro-popliteal and femoro-tibial bypasses in 140 revascularization operations carried out with modified heterologous bovine carotid artery grafts (Solcograft) is presented. The cumulative patency rate was 43% after 5 years for the above-knee and 33% for the below-knee femoro-popliteal bypasses. The high early and late complication rates (37% and 35%) lead us to believe that this graft should also no longer be employed. The human umbilical cord vein (Meadox-Dardik-Biograft) was used in performing 68 femoro-popliteal and 15 femoro-crural bypasses in 60 limbs of 57 patients. The patency rates calculated according to the standard life table method was 36% for the above-knee (after 5 years) and 32% for the below-knee femoro-popliteal bypass (after 4 years) and 31% (after 3 years) for the femoro-tibial bypass, respectively. On the understanding that other materials should be preferred in the individual case, this material still seems to be recommendable as a graft of second or third choice.

Homologous veins as an arterial substitute: Long-term results

From 1968 through 1982, 129 homologous vein grafts were used in 91 patients in the following positions: 75 in the femoropopliteal, tibial, or peroneal artery; 38 in the aortocoronary artery; 13 in the aortopulmonary artery; and one each in the atrioventricular fistula, carotid-subclavian artery, and brachial-radial artery. In the lower extremity patency ranged from 0 to 121 months (mean 22.4 ± 4.4 months). All grafts were performed for limb salvage, and 75% of the patients had undergone previous operations. Cumulative patency by the life-table method showed that while 50% of grafts occluded by 1 year, 60% of the remaining grafts continued to be functional for more than 5 years. Fifty percent of the aortocoronary bypass grafts studied were occluded at 1 year. Eight of the 13 systemic pulmonary artery shunts were patent at time of death, revision, or total correction. Multiple revisions and thrombectomies are required to maintain patency of homograft veins. The outcome is variable and unpredictable. The inconsistency is due to the antigenicity of the graft. If one is committed to the necessary efforts required to ensure long-term patency, the homologous saphenous vein is a suitable substitute when autogenous tissue is unavailable.

Homologous veins as an arterial substitute: long-term results.

From 1968 through 1982, 129 homologous vein grafts were used in 91 patients in the following positions: 75 in the femoropopliteal, tibial, or peroneal artery; 38 in the aortocoronary artery; 13 in the aortopulmonary artery; and one each in the atrioventricular fistula, carotid-subclavian artery, and brachial-radial artery. In the lower extremity patency ranged from 0 to 121 months (mean 22.4 +/- 4.4 months). All grafts were performed for limb salvage, and 75% of the patients had undergone previous operations. Cumulative patency by the life-table method showed that while 50% of grafts occluded by 1 year, 60% of the remaining grafts continued to be functional for more than 5 years. Fifty percent of the aortocoronary bypass grafts studied were occluded at 1 year. Eight of the 13 systemic pulmonary artery shunts were patent at time of death, revision, or total correction. Multiple revisions and thrombectomies are required to maintain patency of homograft veins. The outcome is variable and unpredictable. The inconsistency is due to the antigenicity of the graft. If one is committed to the necessary efforts required to ensure long-term patency, the homologous saphenous vein is a suitable substitute when autogenous tissue is unavailable.

Aortocoronary Bypass with Homologous Saphenous Vein: Long-Term Results

Between February, 1973, and February, 1979, 27 homologous saphenous veins were used in 20 patients (mean age, 54 years). Seven fresh grafts were used less than 24 hours after severance. They were kept at a temperature of 4°C in saline solution containing penicillin. Twenty cryopreserved grafts were used within a period of eight days to 2 months from severance. They were preserved in glycerol at a temperature of −40°C. One patient (5%) died postoperatively. A perioperative myocardial infarction developed in 3 patients (15%). Average follow-up is 27 months. No late mortality was registered. Fifteen patients are free from symptoms, and 3 patients have residual angina with exercise. Control angiograms were made in 13 patients 1 to 68 months after operation; 17 homografts were seen. Early occlusion of 1 graft and late occlusion of 8 grafts were registered. The poor late patency rate does not seem to be related to either histocompatibility or technical conditions. Conversely, microscopic examination of several cryopreserved grafts showed that the mode of preservation resulted in deterioration of intimal and medial tissues of the vein. Therefore, it appears to us that the use of homologous saphenous veins should be avoided for coronary bypass.

Definitive surgical treatment of anomalous origin of left coronary artery: A new technical approach used successfully in a seven-month-old male infant

Anomalous origin of left coronary artery from the pulmonary artery is a very rare cardiac anomaly. Most patients with this defect die in the first year of life. Reconstructive surgery of the left coronary artery is the only saving measure in the management of this disease. A radical operation was successfully carried out in a seven-month-old boy by interposing a homologous saphenous vein (from his mother) between the aorta and left coronary artery. The operation was performed by use of deep hypothermia with surface cooling combined with limited cardiopulmonary bypass. The postoperative clinical course was uneventful and the patient relatively asymptomatic. Postoperative coronary angiograms revealed that the interposed homologous vein graft was patent, although it was slightly stenotic. Following the operation the patient showed good development and growth and has now reached 2 years of age. The purpose of this paper is to present the case by discussing our new operative technique.

Living homologous saphenous vein in geriatric femoropopliteal bypass grafting--report of a case.

Living homologous saphenous vein in geriatric femoropopliteal bypass grafting--report of a case.