Salvage of Solitary Renal Autotransplant with Early Graft Thrombosis and Abdominal Mesh Closure

Insufficient endothelialization of cardiovascular grafts is a major hurdle in vascular surgery and regenerative medicine, bearing a risk for early graft thrombosis. Neither of the numerous strategies pursued to solve these problems were conclusive. Endothelialization is regulated by the endothelial basement membrane (EBM), a highly specialized part of the vascular extracellular matrix. Thus, a detailed understanding of the structure–function interrelations of the EBM components is fundamental for designing biomimetic materials aiming to mimic EBM functions. In this review, a detailed description of the structure and functions of the EBM are provided, including the luminal and abluminal interactions with adjacent cell types, such as vascular smooth muscle cells. Moreover, in vivo as well as in vitro strategies to build or renew EBM are summarized and critically discussed. The spectrum of methods includes vessel decellularization and implant biofunctionalization strategies as well as tissue engineering-based approaches and bioprinting. Finally, the limitations of these methods are highlighted, and future directions are suggested to help improve future design strategies for EBM-inspired materials in the cardiovascular field.

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Heparin-PF4 Antibodies Are Frequent after Vascular Surgery, but Not a Frequent Cause of Graft Thrombosis or Thrombocytopenia.

Blood ◽

10.1182/blood.v108.11.1491.1491 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1491-1491

Author(s):

Tamas Alexy ◽

Sony Tucker ◽

Soames Boyle ◽

Leanne Rochanda ◽

Douglas Hood ◽

...

Keyword(s):

Vascular Surgery ◽

Graft Failure ◽

Bypass Graft ◽

Structural Defects ◽

Graft Thrombosis ◽

Blood Samples ◽

Post Surgery ◽

Platelet Aggregometry ◽

Early Graft ◽

Early Graft Failure

Abstract Surgical intervention for atherosclerotic disease of the aortoiliac and femoral-popliteal arteries has significantly reduced the incidence and complications of peripheral ischemia. However, surgical correction of obstructive arterial lesions can be complicated by either early graft failure due to acute thrombosis or late stenosis of the vascular bypass graft. Despite improvements in surgical technique, early graft failure is still observed in up to 10% of patients and up to 30 % can subsequently develop a graft stenosis. The etiology of early graft closure is less clearly understood. Anatomic or structural defects in the new graft may result in early thrombosis. Underlying prothrombotic conditions have also been suggested as contributing factors to early graft thrombosis. Recently, we have observed recurrent thrombotic events occurring in vascular grafts in two patients who were subsequently diagnosed with the syndrome of Heparin-Induced Thrombocytopenia. Because of these events we undertook an IRB approved, prospective evaluation of HIT antibodies in patients undergoing vascular surgery. Patients undergoing infra-inguinal bypass surgery for atherosclerotic vascular disease were enrolled after informed consent. Blood samples were obtained the day before surgery, day of hospital discharge, at days 14 and 28 after surgery. Platelet counts were obtained on the day of discharge and on post-surgery day 14. Plasma samples were assayed for PFA-heparin antibodies by ELISA (Stago Diagnostica) and platelet activating antibodies by platelet aggregometry. All assays were performed in duplicate. Seventy-nine patients were enrolled. Six (7.7%) patients provided only the pre-surgical blood specimen and only 68 (86%) patients provided all four blood specimens. All but 5 patients reported previous heparin exposure. Of the 73 patients in which post-surgical blood samples were taken, 28 (38%) became ELISA positive for PF4-Heparin antibodies. When tested for platelet activating antibodies, 7 (10%) were positive. All patients who developed a positive ELISA had antibody detected by day 14. Four patients tested positive by ELISA prior to surgery, with 3/4 having positive aggregation assays. One ELISA negative patient developed early graft closure. No patient developed thrombocytopenia or a 50% or greater decrease in platelet count. Patients undergoing vascular surgery frequently develop PF4-Heparin antibodies of which up to 10% patients have platelet activating antibodies. However, both thrombocytopenia and vascular graft thrombosis due to HIT is a rare event.

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Completion duplex ultrasound predicts early graft thrombosis after crural bypass in patients with critical limb ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.04.021 ◽

2011 ◽

Vol 54 (4) ◽

pp. 1006-1010 ◽

Cited By ~ 14

Author(s):

Salvatore T. Scali ◽

Adam W. Beck ◽

Brian W. Nolan ◽

David H. Stone ◽

Randall R. De Martino ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Graft Thrombosis ◽

Early Graft

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Antithrombotic Management in Adult Kidney Transplantation – A European survey study

European Surgical Research ◽

10.1159/000521327 ◽

2021 ◽

Author(s):

Tamar A. J. van den Berg ◽

Ton Lisman ◽

Frank J.M.F. Dor ◽

Cyril Moers ◽

Robert C. Minnee ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Loss ◽

Bleeding Risk ◽

Survey Study ◽

Graft Thrombosis ◽

Adult Kidney ◽

Management Protocol ◽

Early Graft ◽

Other Regarding ◽

Antithrombotic Management

In kidney transplantation (KTx), renal graft thrombosis (RGT) is one of the main reasons for early graft loss. Although evidence-based guidance on prevention of RGT is lacking, thromboprophylaxis is widely used. The aim of this survey was to obtain a European view of the different thromboprophylactic strategies applied in KTx. An online 22-question survey, addressed to KTx professionals, was distributed by e-mail and via platforms of the European Society for Organ Transplantation. Seventy-five responses (21 countries, 51 centers) were received: 75% had over 10 years’ clinical experience, 64% were surgeons, 29% nephrologists and 4% urologists. A written antithrombotic management protocol was available in 75% of centers. In 8 (16%) of centers respondents contradicted each other regarding the availability of a written protocol. Thromboprophylaxis is preferred by 78% of respondents, independent of existing antithrombotic management protocols. Ninety-two percent of respondents indicated that an anticipated bleeding risk is the main reason to discontinue chronic antithrombotic therapy preoperatively. Intraoperatively, 32% of respondents administer unfractionated heparin (400 – 10.000 international units with a median of 5000) in selected cases. Despite an overall preference for perioperative thromboprophylaxis in KTx, there is a high variation within Europe regarding type, timing and dosage, most likely due to the paucity of high-quality studies. Further research is warranted in order to develop better guidelines.

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Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(05)80140-x ◽

1994 ◽

Vol 8 (12) ◽

pp. 651-656 ◽

Cited By ~ 40

Author(s):

A KALANGOS ◽

G TAYYARECI ◽

R PRETRE ◽

P DIDIO ◽

O SEZERMAN

Keyword(s):

Myocardial Revascularization ◽

Graft Thrombosis ◽

Early Graft

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Completion duplex ultrasound predicts early graft thrombosis after crural bypass in patients with critical limb ischemia

Yearbook of Vascular Surgery ◽

10.1016/j.yvas.2012.04.085 ◽

2012 ◽

Vol 2012 ◽

pp. 60-61

Author(s):

M.A. Passman

Keyword(s):

Critical Limb Ischemia ◽

Duplex Ultrasound ◽

Limb Ischemia ◽

Graft Thrombosis ◽

Early Graft

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Preoperative thromboxane A2/prostaglandin H2 receptor activity predicts early graft thrombosis

Journal of Vascular Surgery ◽

10.1016/s0741-5214(98)70362-3 ◽

1998 ◽

Vol 27 (2) ◽

pp. 317-328 ◽

Cited By ~ 3

Author(s):

Thomas E. Brothers ◽

Jacob G. Robison ◽

Bruce M. Elliott ◽

Janet M. Boggs

Keyword(s):

Thromboxane A2 ◽

Receptor Activity ◽

Graft Thrombosis ◽

H2 Receptor ◽

Early Graft

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Reduction of early vein graft thrombosis by tissue plasminogen activator gene transfer

Thrombosis and Haemostasis ◽

10.1160/th08-11-0772 ◽

2009 ◽

Vol 102 (07) ◽

pp. 145-152 ◽

Cited By ~ 10

Author(s):

Marcella J. Wyatt ◽

Andrew C. Newby ◽

Anita C. Thomas

Keyword(s):

Blood Flow ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Ex Vivo ◽

Arterial Stenosis ◽

Graft Thrombosis ◽

Vein Grafts ◽

Cyclic Flow ◽

Tissue Plasminogen ◽

Early Graft

SummaryVein grafts are used to bypass coronary arterial stenosis, but many grafts thrombose soon after surgery. A model was developed in the pig to allow continuous measurement of blood flow and production of flow-restricting thrombi (cyclic flow reductions; CFRs). Saphenous vein lumen was exposed to adenovirus ex vivo, to over-express human tissue plasminogen activator (h-tPA), with β-galactosidase adenovirus as a control. The vein segmen ts were engrafted into carotid arteries and examined 0,1 or 3 days later (4–7 animals/group). Untransduced grafts examined on the day of surgery developed repeated CFRs at both normal and restricted flow, but their frequency declined in grafts examined after 3 days. Adenovirus transduction was evident as β-galactosidase or h-tPA expression 1 day after engraftment. Blood flow was increased 1.4-fold in h-tPA transduced grafts after 1 day [control 390 (280–510), h-tPA 550 (450–660) ml/min; p=0.02 (expressed as mean (95% confidence intervals)]. CFRs were less severe (p=0.002) in the h-tPA transduced grafts than β-galactosidase-transduced grafts. CFRs were also less frequent in unstenosed undamaged h-tPA grafts [control 17 (6.1–29), h-tPA 7.6 (1.7–14) CFR/hr; p=0.02], but this difference was reduced after damage or stenosis. CFRs formed faster in h-tPA than in β-galactosidase-transduced grafts [control 14 (11–17), h-tPA 23 (19–27) ml/min2; p<0.001], and resolved twofold faster [control 25 (22–30), h-tPA 48 (39–60) ml/min2; p<0.001]. Hence, in this model, local gene therapy with h-tPA increased graft blood flow and decreased measures of early graft thrombosis, namely quicker CFR resolution and decreased frequency and severity.

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