Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta

Reconstruction after the resection of a pelvic tumor is a challenging procedure in orthopedic oncology. The main advantage of allograft reconstruction is restoration of the bony architecture of the complex pelvic region. However, high complication rates such as infection and allograft resorption had been reported in the literature. In this study, we aimed to retrospectively review nine patients treated with pelvic resection and structural pelvic allograft reconstruction. Functional results, complications, and survival of the patients and the allografts were evaluated. At a mean follow-up of 79 months, three patients were dead. Major complications were detected in eight of the nine patients. Infection (four of the nine patients) and allograft resorption (three of the nine patients) were the most common causes of failure. The cumulative survival of the patients was 66.7 percent at 70 months. However, allograft survival was only 26.7 percent at 60 months. Mean MSTS score was 69. In conclusion, we suggest that other reconstruction options should be preferred after pelvic resections because of the high complication rates associated with massive allograft reconstruction.

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Primary Self-Expandable Nitinol Stent Placement in Focal Lesions of Infrarenal Abdominal Aorta: Long Term Results

CardioVascular and Interventional Radiology ◽

10.1007/s00270-007-9222-3 ◽

2007 ◽

Vol 31 (1) ◽

pp. 43-48 ◽

Cited By ~ 6

Author(s):

Jarmila Laštovičková ◽

Jan H. Peregrin

Keyword(s):

Abdominal Aorta ◽

Stent Placement ◽

Long Term Results ◽

Focal Lesions ◽

Nitinol Stent ◽

Infrarenal Abdominal Aorta

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Long-term results of arterial allograft below-knee bypass grafts for limb salvage: A retrospective multicenter study

Journal of Vascular Surgery ◽

10.1067/mva.2000.103792 ◽

2000 ◽

Vol 31 (3) ◽

pp. 426-435 ◽

Cited By ~ 39

Author(s):

J.N. Albertini ◽

X. Barral ◽

A. Branchereau ◽

J.P. Favre ◽

H. Guidicelli ◽

...

Keyword(s):

Limb Salvage ◽

Multicenter Study ◽

Long Term Results ◽

Bypass Grafts ◽

Arterial Allograft ◽

Retrospective Multicenter Study

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Early and long-term results of percutaneous transluminal angioplasty of the lower abdominal aorta

Journal of Vascular Surgery ◽

10.1016/s0741-5214(99)70107-2 ◽

1999 ◽

Vol 30 (4) ◽

pp. 679-692 ◽

Cited By ~ 9

Author(s):

Stéphane Elkouri ◽

Gilles Hudon ◽

Philippe Demers ◽

Lise Lemarbre ◽

Raymond Cartier

Keyword(s):

Abdominal Aorta ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Long Term Results ◽

Percutaneous Transluminal

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Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.06.041 ◽

2008 ◽

Vol 34 (4) ◽

pp. 805-809 ◽

Cited By ~ 12

Author(s):

Beltran G. Levy Praschker ◽

Pierre Mordant ◽

Eleodoro Barreda ◽

Iradj Gandjbakhch ◽

Alain Pavie

Keyword(s):

Abdominal Aorta ◽

Ascending Aorta ◽

Long Term Results

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Coarctations of descending and abdominal aorta: Long-term results of surgical therapy

Journal of Vascular Surgery ◽

10.1016/s0741-5214(98)70156-9 ◽

1998 ◽

Vol 28 (2) ◽

pp. 206-214 ◽

Cited By ~ 29

Author(s):

Volker Mickley ◽

Thorsten Fleiter

Keyword(s):

Surgical Therapy ◽

Abdominal Aorta ◽

Long Term Results

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Surgical treatment of abdominal tumors closely related to major blood vessels

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0806241d ◽

2008 ◽

Vol 136 (5-6) ◽

pp. 241-247

Author(s):

Lazar Davidovic ◽

Radomir Sindjelic ◽

Nebojsa Savic ◽

Dusan Kostic ◽

Slobodan Cvetkovic ◽

...

Keyword(s):

Surgical Treatment ◽

Blood Vessels ◽

Abdominal Aorta ◽

Vena Cava ◽

Life Quality ◽

Long Term Results ◽

Vena Cava Inferior ◽

Abdominal Tumors ◽

Hospitalization Period

INTRODUCTION Radical operative treatment of abdominal tumors closely related to major blood vessels often demands complex vascular procedures. OBJECTIVE The aim of this paper was to present elementary principles and results of the complex procedures, based on 46 patients operated on at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, from January 1999 to July 2006. METHOD Primary localization of the tumor was the kidney in 14 patients, the suprarenal gland in 2, the retroperitoneum in 23 and the testis in 7 patients. Histologically, the most frequent were the following: renal carcinoma in 14 patients, teratoma in 7, liposarcoma in 5, fibrosarcoma and lymphoma in 3 patients. The tumor compressed abdominal aorta occurred in 3 cases, vena cava inferior in 5 and both the abdominal aorta and vena cava inferior in 11 cases. In 4 cases the tumor infiltrated the abdominal aorta, in 11 the vena cava inferior and in 8 both of them. In two patients, the tumor compressed the vena cava inferior and infiltrated the aorta; in two patients the aorta was compressed and the vena cava was infiltrated. In three cases only the exploration was performed due to multiple abdominal organ infiltration. The ex tempore biopsy showed the type of tumor in which the radical surgical treatment did not improve the prognosis. In 20 cases of tumor compression, subadventitional excision was performed. In 23 cases of infiltration, the tumor excision and vascular reconstruction had to be performed. Intraoperative blood cell saving and autotransfusion were applied in 27 patients. RESULTS The lethal outcome happened in 3 (6.5%) patients during hospitalization. In other patients all reconstructed blood vessels were patent during the postoperative hospitalization period. CONCLUSION Treatment of the abdominal tumors closely related to major blood vessels must be interdisciplinary, considering diagnostics, operability estimation and additional measures. Tumor reduction cannot improve long term prognosis, and has no major impact on life quality. There have been not many papers that analyze the long term results after such complex operations proving their appropriateness.

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In situ replacement of infected vascular prosthesis with fresh arterial homograft: Early and long-term results in 18 patients

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1312750p ◽

2013 ◽

Vol 141 (11-12) ◽

pp. 750-757

Author(s):

Sinisa Pejkic ◽

Nenad Jakovljevic ◽

Ilija Kuzmanovic ◽

Miroslav Markovic ◽

Slobodan Cvetkovic ◽

...

Keyword(s):

Graft Infection ◽

Vascular Prosthesis ◽

Long Term Results ◽

Prosthetic Material ◽

Prosthetic Reconstruction ◽

Arterial Allograft ◽

In Situ Replacement

Introduction. Graft infection is rightly considered one of the severest complications of vascular reconstruction. Treatment is non?standardized and associated with high mortality and morbidity rates. The choice of therapeutic modality depends upon variety of factors. One increasingly used option is in situ replacement of the infected prosthesis with the arterial allograft. Objective. The aim of this prospective nonrandomized study was to evaluate the effectiveness and durability of fresh arterial allograft as in situ substitute for the infected vascular prosthesis. Methods. During period of 2002-2005, 18 patients with the synthetic vascular graft infection underwent partial or complete prosthesis removal and secondary in situ reconstruction using the fresh arterial allograft, preserved under hypothermic conditions in buffered saline solution with an addition of antibiotics. Results. In 14 male and 4 female patients, meanaged 62 years, 8 aortic and 10 peripheral arterial infected prostheses were partially or completely replaced with the allograft. Operative mortality was 27.8% and amputation rate was 22.2%. Systemic sepsis at initial presentation and highly virulent nature of causative microorganisms were identified as significant negative prognostic factors (?? test, p<0.05). During the long?term follow?up (mean 47 months), allograft aneurysm developed in three patients, requiring allograft explantation, followed in two cases by tertiary prosthetic reconstruction. Conclusion. Substitution of the infected prosthesis with the arterial allograft could be successful if used selectively - for less virulent and localized infections of extracavitary grafts. Close follow?up is mandatory for timely diagnosis of late homograft lesions and its eventual replacement with more durable prosthetic material.

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