The Use of Cryopreserved Venous Allografts in Microvascular Surgery without Immunosuppression: An Experimental Study

Narayanan, Krishna; Ahn, Christina Y.; Monstrey, Stan; Tran, Sothi; Liang, Marc D.

doi:10.1055/s-2007-1006665

Cited by 10 publications

(3 citation statements)

References 7 publications

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“…Raman et al= also reported that patency rates of femoral arteries in New Zealand white rabbits after allogeneic transplantation using the freeze-dry method was not satisfactory. Narayanan et al 26 reported satisfactory results after 21 days with cryopreserved venous grafts, though depression of vein immunogenicity may require longer follow-up since rejection a p pears 3 weeks after transplantation. Transmission electron microscopic (TEM) studies have shown that the result of preservation obviously differs from freeze-dried tissues to cryopreserved tissues.…”

Section: Discussionmentioning

confidence: 99%

Experimental study of cryopreserved allogeneic transfer of vessel: Preliminary report

1994

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It has long been known that the antigenicity of tissues is depressed when they are kept at a very low temperature. In this study, Lewis rats and Brown Norway (B.N.) rats were used because these species are significantly dissimilar at the major histocompatibility complex (MHC) Femoral arteries were harvested from Lewis rats, frozen while lowering the temperature in a stepwise fashion to -70 degrees C. After three weeks of cryogenic storage, the arteries were transplanted into Lewis and B.N. rats. At various times from the first to the twelfth week after surgery, grafted vessels were observed, and pathological and electron microscopic studies were carried out. The vessels were found to be in good condition at the end of the 12 week observation period. These results strongly suggest that prolonged cryopreservation of vessels makes allotransplantation without immunosuppression possible.

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Section: Discussionmentioning

confidence: 99%

Experimental study of cryopreserved allogeneic transfer of vessel: Preliminary report

1994

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“…12 The antigenicity of the tissue also appears to be reduced by freezing. 13 " 16 These results seem inspiring for the future establishment of a "tissue bank." However, there has been little description of the fate of endothelial cells at the vascular pedicle and in the capillary bed, the viability of which is critical to the long-term survival of composite tissue.…”

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confidence: 84%

Effect of Cryopreservation on Survival of Composite Tissue Grafts

Zhang¹,

Attkiss²,

Walker³

et al. 1998

J reconstr Microsurg

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The problems in cryopreserving complex tissues remain poorly understood. In the present study, the viability of cryopreserved complex tissue, including skin and muscle flaps, and tail, was compared to simple artery and vein grafts in a rat model. Forty-four grafts, including the femoral artery (n = 15), femoral vein (n = 9), gracilis muscle flap (n = 8), groin cutaneous flap (n = 9), and tail (n = 3) were cryopreserved at -196 degrees C for 1 to 2 weeks, and then microvascularly transferred to analogous sites in inbred recipient animals. Three to 60 days post-transplant, all cryopreserved femoral arteries and veins were patent. Host groin cutaneous flaps with cryopreserved vessels grafted into the arterial pedicle survived with no complications However, severe endothelial-cell damage with extensive sloughing in the grafts was demonstrated at 30 min and 1 week following reperfusion, using factor VIII immunologic stain. Reendothelialization was evident at 2 months postoperatively. All cryopreserved composite tissue underwent early pedicle thrombosis The muscle and cutaneous tissue also showed gross and microscopic edema, with extensive red-cell extravasation within 30 min of reperfusion Cryopreservation thus can maintain the functional integrity of simple vessel grafts, but these grafts survive only as a conduit, given the severe endothelial-cell damage The failure of transferred complex cryopreserved tissue may reflect a combination of cellular or architectural damage to the capillary bed from ice formation during the freezing process and from reperfusion injury.

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“…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. 29 These success rates may be, in part, due to the relatively small length of the interposition graft, allowing for spontaneous re-endothelialization following immune-mediated rejection of the allograft.…”

Section: Cryopreserved Venous and Arterial Allograftsmentioning

confidence: 95%

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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The Use of Cryopreserved Venous Allografts in Microvascular Surgery without Immunosuppression: An Experimental Study

Cited by 10 publications

References 7 publications

Experimental study of cryopreserved allogeneic transfer of vessel: Preliminary report

Experimental study of cryopreserved allogeneic transfer of vessel: Preliminary report

Effect of Cryopreservation on Survival of Composite Tissue Grafts

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

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