Fresh and Cryopreserved Arterial Homografts in the Treatment of Prosthetic Graft Infections: Experience of the Italian Collaborative Vascular Homograft Group

The Role of Cyclosporine A in the Treatment of Prosthetic Vascular Graft Infections with the Use of Arterial Homografts

“…In this situation, the usage of immunosuppressive drugs is reasonable. However, we agree that the ABO compatibility is essential (Bracale et al,1999;Chiesa et al,1998;Prager et al,2002). Clinical trials show that there are changes in an arterial homograft's wall typical for a chronic rejection process (Allaire et al,1994;Bandyk et al,2001;Mirelli et al,1999;Ruotolo et al,1997).…”

“…There are also numerous research studies showing that the usage of fresh arterial homografts with a preserved endothelium is associated with the immunological response of the graft recipient. This suggests the importance of the selection of donors of the same blood type and similar HLA histocompatibility when fresh arterial allografts are to be used (Chiesa et al,1998;da Gama et al,1994;Mirelli et al,1998Mirelli et al, , 1999Prager et al,2002). We believe that in life threatening infections, the transplantation of the artery despite a slightly positive cross-match is acceptable.…”

“…Encouraging results were obtained when cold-preserved fresh arterial homografts and other biologic grafts were used to replace infected prosthetic grafts (Chiesa et al,1998(Chiesa et al, , 2002. Cooling down the grafts only to 4 O C allows preservation of the arterial endothelium.…”

Current options in prosthetic vascular graft infection: comparative analysis of 63 consecutive cases

“…Only the introduction of thermic preservation techniques enabled better results to be obtained, related to the limitation of early mortality rates to 13%-17% and overall mortality rates to 20%-25% [19,20,21]. In addition, the frequency of amputations is lowered and does not exceed 5% [21]. Both the death rate among our patients (13.6%) and the causes of death do not differ significantly from those in earlier publications.…”

“…Currently, it is assumed that these complications were mostly connected with the fresh grafts' maintaining unchanged antigenecity, stipulating excessive infiltration of macrophages and plasmatic cells, whose enzymes enforced the degeneration of elastic and collagen fibres [18]. Only the introduction of thermic preservation techniques enabled better results to be obtained, related to the limitation of early mortality rates to 13%-17% and overall mortality rates to 20%-25% [19,20,21]. In addition, the frequency of amputations is lowered and does not exceed 5% [21].…”