Homologous Vein Grafts Research Articles

Clinical experiences with untreated homologous vein grafts in reconstruction of arteries (author's transl)

50 transplantations of homologous vein grafts in reconstruction of arteries are reported on. Vein grafts were either transplanted immediately or used after deep freezing. This procedure has proved to be effective in the replacement of arteries during our observation period of four years. Results of homologous vein transplants are similar to those of autologous transplants.

New technique for construction of coposite Dacron vein grafts for femoro-distal popliteal bypass in the severely ischemic leg.

Vascular surgeons are in agreement that autogenous saphenous veins are best suited for bypasses from the common femoral artery to the distal popliteal artery in the management of femoropopliteal occlusive disease associated with the severely ischemic foot. Such a graft should be of adequate size (more than 3 mm in diameter) throughout its length for a successful outcome. In some patients the vein is of good size for 15 or 20 cm then branches into several small veins. Reports by most surgeons are unfavorable concerning the use of prostheses and bovine heterografts for anastomosis to the distal popliteal artery or to one of its branches. Our experience with composite dacron vein graft bypasses employing a fluted end-to-end anastomosis had been unfavorable and was similar to the experience of Dale (1962). In July 1973 we were forced to improvise the technique of end-to-side anastomosis joining the end of a dacron prosthesis to the side of the vein graft for a femorodistal popliteal bypass. During the ensuing 15 months we have carried out this composite graft only when the greater saphenous vein was not of adequate size throughout. In 17 limbs the composite graft was placed between the common femoral artery and the distal popliteal artery and on 6 occasions to the posterior tibial and peroneal arteries. Nineteen limbs exhibited either gangrene, impending gangrene, ischemic ulceration or severe rest pain. In four extremities intermittent claudication of a progressive and disabling degree was the indication for operation. Eleven of the 22 patients were diabetic. Run-off beyond the popliteal artery was poor in 16 of the 23 limbs and inflow was subnormal in three patients. During the followup period, 10 grafts have occluded, one day to 6 1/2 months postoperatively, two due to inflow deficiency, 5 due to poor outflow, one to an error in technique, and two occluded without known cause. Two patients came to major amputation following closure of their grafts, 3 and 7 months postoperatively. Results with the composite graft are compared with the bovine heterograft and the homologous vein graft.

Viable vein graft preservation

Homologous vein grafts are becoming increasingly useful in patients without suitable autologous saphenous veins for peripheral arterial bypass procedures [4, 81. However, fresh veins are the only tissue that has been used successfully in homograft vascular reconstruction in terms of long-term patency [4]. The advantages of a reliable method of long-term storage of viable vein segments and the ultimate creation of a vein “bank” are therefore apparent. Dimethylsulfoxide (DMSO) is a low molecular weight compound that diffuses readily across cell membranes [2] and has been shown to be an effective cryoprotectant avoiding cellular dehydration, a major cause of cell death during freezing [2]. The DMSO has been used for successful cryopreservation of other tissues [3, 61, but has not been utilized for vein graft preservation. This study assesses a method for the longterm preservation of viable vein segments by freezing in liquid nitrogen with DMSO cryopreservation.

Canaliculus Reconstruction with Homologous Vein Graft

Canaliculus Reconstruction with Homologous Vein Graft

Replacement of venous defects by venous autografts.

At the present time there are few indications for the repair or replacement of venous defects. As the scope of surgery grows, however, reconstitution of the vena cava and other major veins will require the availability of suitable graft material. There is, at present, no definitive answer as to which type of replacement is most desirable for venous reconstruction. Indications for venous reconstruction presumably will include circumstances in which the superior vena cava, the inferior vena cava above the renal veins, the superior mesenteric veins, the portal vein, or one or both renal veins are involved by tumor, trauma, thrombosis or postinflammatory obliteration. Other indications might include instances in which major venous shunts are required, as in the surgery of congenital anomalies of the heart and great vessels, or in portal to systemic shunting procedures. The present study was undertaken first to compare autogenous with homologous vein grafts, and secondly