Early results with cryopreserved saphenous vein allografts for infrainguinal bypass

Shah, Rasesh; Faggioli, Gianluca; Mangione, Sherry; Harris, Linda M.; Kane, J.; Taheri, Syde A.; Ricotta, John J.

doi:10.1016/0741-5214(93)90551-v

Cited by 44 publications

(9 citation statements)

References 18 publications

(3 reference statements)

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“…1,7,8 Early reports from our group and others indicated that there is a high incidence of portal vein vascular complications when venous conduits are used to reconstruct the donor and recipient portal vein. 9,10 The reported incidence of early portal vein thrombosis varies between 0% to 30%, depending on the series selected. 9,[13][14][15][16] Several factors have been implicated, including portal vein size, type of graft used, and positional factors.…”

Section: Discussionmentioning

confidence: 99%

“…9 Analysis of patients who received a living donor graft demonstrated that the most significant contributor to early portal vein thrombosis was the use of venous conduits, and most commonly a cryopreserved venous extension. 9,10 As a result of the high incidence of portal venous complications associated with the use of cryopreserved iliac veins, we eliminated all venous conduits, which decreased the incidence of early portal vein thrombosis. Early living related and reduced-size pediatric grafts were implanted to the right hepatic vein.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Buell¹,

Funaki²,

Cronin³

et al. 2002

Annals of Surgery

252

205

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ObjectiveTo assess the long-term incidence of venous complications, including portal vein and hepatic vein stenoses, in both whole cadaveric and reduced-size cadaveric and living related liver transplants in a pediatric population, and to assess the therapeutic modalities in the treatment of these lesions. Summary Background DataA shortage in appropriate-sized liver grafts for pediatric patients led to the use of segmental liver grafts, which became the predominant graft used in 325 of 600 (54%) transplants at the authors' institution. To assess the long-term impact of this strategy, the authors examined the incidence of late (Ͼ90 days) venous complications and the efficacy of all therapeutic interventions. MethodsSix hundred pediatric liver transplants were performed in 325 patients, with reduced-size or split (RSS; n ϭ 207), living related (LRD; n ϭ 118), or full-size cadaveric grafts (FS; n ϭ 275) from 1988 to 2000. All transplants identified with late portal vein or vena caval stenoses or thromboses from a cohort of 524 grafts with survival greater than 90 days were reviewed for demographics, symptoms, therapeutic intervention, recurrence, morbidity, and mortality. ResultsFifty lesions were identified in 49 patients (38 portal vein and 12 hepatic vein-cava stenoses). Sex distribution was similar between portal vein and hepatic vein to cava, as was the mean patient age. Portal vein stenoses occurred in 32 LRD, 3 RSS, and 3 FS, while hepatic vein-cava stenoses occurred in 2 LRD, 8 RSS, and 2 FS. In the 38 portal vein stenoses, 9 had prior perioperative portal vein and/or 5 hepatic artery thrombectomies. Portal vein stenoses were identified after bleeding (17/38), ascites (6/38), increased liver function tests (6/38), splenomegaly (5/38), or screening ultrasound (4/38). Portal vein stenosis was associated most often with cryopreserved vein for portal conduits. Excluding conduits, the incidence of late portal vein complications was reduced to 1%. Lesions became symptomatic at a mean of 50.8 Ϯ 184.2 months posttransplant. All patients underwent venous angioplasty with a 66% (25/38) success rate, while 7 of 25 required further angioplasty and stenting. In the 13 unsuccessful angioplasties, 8 required surgical shunts for complete portal vein thrombosis. Recurrence occurred in 9 patients: all were amenable to stenting. Nine patients (24%) eventually died of sepsis (4) and surgical deaths at shunt or retransplant (5). Hepatic vein-cava stenoses occurred after a mean of 37.2 Ϯ 35.2 months, presenting with ascites (n ϭ 10), increased liver function tests (n ϭ 2), and splenomegaly (n ϭ 2). All patients were diagnosed by venogram and managed by balloon dilatation alone (n ϭ 6) or stented (n ϭ 4), with an 80% (10/12) success, with two late recurrences amenable to repeat angioplasty or stenting. Long-term survival was 80% at 1 year. ConclusionsThe use of segmental grafts without venous conduits is not associated with a significant rate of long-term venous complication. When late venous complications do occur, venous angiop...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Buell¹,

Funaki²,

Cronin³

et al. 2002

Annals of Surgery

252

205

View full text Add to dashboard Cite

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“…Many reports have indicated that there is a high incidence of portal vein complications when venous conduits are used to reconstruct the donor and recipient portal veins. 4,5 The reported incidence of early portal vein thrombosis varies between 0% and 30%, depending on the series selected. [6][7][8][9] Several factors have been implicated, including the portal vein size, type of graft used, and graft positional factors.…”

Section: Discussionmentioning

confidence: 99%

Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation

Cheng

Tsang

et al. 2009

Liver Transpl

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A 2-year-old Chinese boy with progressive familial intrahepatic cholestasis type II-related end-stage liver disease underwent living donor liver transplantation (LDLT) using a left lateral segment graft from his mother. Preoperative computed tomography angiography showed that the hepatic artery, inferior vena cava, and portal vein were patent. The left portal vein of the graft was connected to the recipient's right anterior portal vein. The left hepatic vein of the graft was connected to the recipient's hepatic veins with triple venoplasty. The left hepatic artery of the graft was connected to the recipient's right hepatic artery. The left hepatic duct of the graft was connected to the recipient's common hepatic duct with a microsurgical technique.After the operation, the infant underwent reworking of the hepatic artery anastomosis twice because of early hepatic artery thrombosis. He also underwent revision of the biliary reconstruction to Roux-en-Y hepaticojejunostomy because of biliary anastomotic stricture. At 18 months post-transplant, there was poor visualization of the intrahepatic portal vein, but there was hepatofugal flow inside the left portal vein during Doppler ultrasound follow-up studies. Splenomegaly and minimal ascites were also noted by ultrasound. The computed tomography angiography study showed mild intrahepatic bile duct dilatation, marked splenomegaly, and occlusion of the transverse portion of the portal vein with collateral vessels also noted. The patient was subsequently referred for a possible interventional radiological procedure as initial management for the occluded portal vein.The patient underwent vascular catheter intervention under general anesthesia. The percutaneous transsplenic approach was performed to puncture the splenic vein with a 21-gauge Chiba needle (Cook, Bloomington, IN) under ultrasonographic and fluoroscopic guidance. The needle was changed to a 4-French coaxial dilator and a 7-French sheath (Terumo, Tokyo, Japan) over a 0.035-inch angled hydrophilic guide wire (Terumo) after confirmation that the needle was in the splenic vein. Direct main portal venography and the pressure gradient across the stenosis were then obtained. Portography showed total occlusion of the portal vein at its umbilical portion (Fig. 1). The coronary vein was prominent, and gastroesophageal varices were also noted. The extrahepatic portal pressure was 18 mm Hg, and the intrahepatic portal pressure was 18 mm Hg. Hence, there was no pressure gradient across the area of stenosis. A 0.035-inch guide wire and a 4-French J curve catheter (Terumo) were used to traverse the area of portal vein stenosis (Fig. 2). A wall stent (9.0 mm ϫ 5.0 cm; Boston Scientific, Natick, MA) was placed to bypass the area of stenosis from the umbilical portion up to the visualized segment 3 portal vein. A second similarly sized wall stent was placed from the mid portion of the native main portal vein to the splenic vein.Balloon angioplasty (6.0-40 mm, 80 cm; Wanda, BosAbbreviation: LDLT, living donor liver transplantati...

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“…In general, clinical use of cryopreserved venous and arterial allografts in lower extremity revascularization has been complicated by lower patency rates, aneurysmal dilatation, higher cost, and increased risk of bloodborne infectious diseases when compared to autogenous vein and prosthetic grafts. [25][26][27] Narayanan et al reported a 100% patency rate at 21 days in a rat model in which 5-mm-long and 1-mmdiameter cryopreserved femoral veins were used as interposition arterial grafts across major histocompatibility barriers without immunosuppression. 28 Similarly, Hirase et al reported a 100% patency rate of replanted rat hind limbs at 3 months utilizing 1.5-cm-long arterial and venous cryopreserved allografts.…”

Section: Cryopreserved Venous and Arterial Allograftsmentioning

confidence: 99%

New concepts and materials in microvascular grafting: Prosthetic graft endothelial cell seeding and gene therapy

Lio

1998

Microsurgery

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Microsurgical free tissue transfer is currently associated with very high success rates and few complications. While interposition vein grafting is clearly an important adjunct to the microsurgeon's armamentarium, it has been associated with higher free flap/replantation failures and complication rates. With appropriate flap planning and surgical techniques, the need for interposition vein grafting should be quite infrequent and hopefully avoided if at all possible. Nevertheless, when necessary, the vein graft remains the gold standard, with virtually all alternative interposition grafts demonstrating lower patency rates. One of the more promising areas of research is the concept of genetic manipulation of the endothelial cell via molecular biological techniques. It is likely that in the near future this may become a clinical reality, not only improving the patency of microsurgical anastomoses and interposition vein grafts, but quite possibly altering the target organ functionally as well.© 1998 Wiley-Liss, Inc. MICROSURGERY 18:263-266 1998Technical advances in microsurgical expertise, techniques, and suture materials have resulted in free flap success rates of greater than 99% in some clinical series. As microvascular surgery becomes more routine, there is an occasional need, despite preoperative planning, to bridge microvascular defects. Microvascular grafting is clearly an invaluable tool in digital replantation and free tissue transfer to essentially increase the length of the pedicle from the defect to the recipient vessels. The gold standard has long been and continues to be the autogenous vein graft. There is still some controversy regarding the patency rates of free flaps with and without vein grafts. While controlled rat model experiments have demonstrated comparable patency rates for microvascular procedures with and without vein grafts, 1 retrospective clinical reviews often demonstrate lower patency rates in flaps requiring venous interposition grafts.2 The added dissection, surgical time, and possible additional surgical scars of harvesting venous micrografts have led investigators to search for viable alternatives. In order to be considered a viable alternative to the autogenous vein graft, any substitute micrograft should equal the patency rate of vein grafts given the absolute consequences of a failed interpositional graft and subsequent free flap loss.Various synthetic and biologic alternatives to vein grafts have been tried experimentally but, in general, they are complicated by lower patency rates when used as interposition grafts in small diameter low flow vessels. The search for alternate micrografts can be divided into three basic categories: biologic grafts, synthetic or polymer prostheses, and a combination of the two. CRYOPRESERVED VENOUS AND ARTERIAL ALLOGRAFTSRenewed interest in the use of cryopreserved allografts in peripheral vascular surgery has led to several studies exploring the use of these allografts in microsurgery. In general, clinical use of cryopreserved venous and arterial ...

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Early results with cryopreserved saphenous vein allografts for infrainguinal bypass

Cited by 44 publications

References 18 publications

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation

New concepts and materials in microvascular grafting: Prosthetic graft endothelial cell seeding and gene therapy

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