The evaluation of the healing of fresh arterial allografts in infected environments

Abstract

Background. In this paper, 50 cases of massive aorto-ilio-femoral graft infection treated by the replacement of infected prosthesis with arterial homograft in the Departament of Vascular, General and Transplantation Surgery In Wrocław University of Medicine during the years 1999–2003 are presented.
Material and methods. The arterial allograft was stored with the application of cold ischemia method in a preservation solution at 4°C. Duplex-Doppler Ultrasound and scintigraphy with the use of technetiumlabelled leukocytes were used in the diagnostic evaluation of infection and of the healing process of the homograft. During the follow up period, patients in whom fresh homografts were used were divided into two groups: group I received immunosuppressive regimen after surgery (24 patients) and group II received no immunosuppression (26 patients).
Results. In group I, no complications due to the homograft's wall degradation (e.g. graft rupture) were noticed. In group II, complications related to the impairment of the allograft wall were observed: graft rupture, true graft aneurysm and homograft thrombosis. In all groups the regression of infection after in-situ replacement of the synthetic prosthesis with the homograft was monitored with scintigraphy examination.
Conclusion. The use of arterial homograft with the application of cold ischemia method and immunosuppression in the therapy of prosthetic graft infection is a proper treatment method.