Cryopreserved Allografts for Treatment of Chronic Limb-Threatening Ischemia in Patients Without Autologous Saphenous Veins
| Autor: | Jose Luis Pomar, Gustavo Adolfo Lucar-Lopez, Kerbi Alejandro Guevara-Noriega |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Ischemia 030204 cardiovascular system & hematology Revascularization 030218 nuclear medicine & medical imaging Blood Vessel Prosthesis Implantation Peripheral Arterial Disease 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Blood vessel prosthesis medicine Humans Vascular Patency Saphenous Vein Registries Risk factor Survival rate Aged Retrospective Studies Aged 80 and over Bioprosthesis Cryopreservation business.industry Retrospective cohort study General Medicine Middle Aged Allografts medicine.disease Blood Vessel Prosthesis Surgery Treatment Outcome Lower Extremity Bypass surgery Spain Chronic Disease Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 60:379-387 |
| ISSN: | 0890-5096 |
| Popis: | Background Revascularization is the best alternative to reduce symptoms and to improve the limb salvage rate in patients with chronic limb-threatening ischemia (CLI). Alternative grafts as synthetic prostheses and allografts must be considered for patients without a suitable autologous graft. Our aim was to evaluate outcomes of cryopreserved allografts used as a vascular conduit for bypass surgery in the infrainguinal territory. Methods A retrospective analysis (January 1995 to January 2014) of the Registry of vascular and valvular allografts transplant in the autonomous community of Catalonia, Spain was performed for identifying patients with CLI who required infrainguinal bypass with cryopreserved arterial allografts. Statistical analysis was performed using SPSS, ver. 20, for Mac (Chicago). Results A total of 149 patients with CLI (mean age of 70.1 years) were analyzed. One hundred two patients (68.5%) had a grade IV lesion (Fontaine classification). In the overall follow-up, 24.8% of patients required a reintervention. Overall graft occlusion, infection, and dilation rate were 52.3%, 6%, and 5.4% respectively. Overall 30-day mortality was 0.7%. Five-year primary patency rate and limb salvage rate were 38.6% and 50.2%, respectively. Survival rate at 5 years was 54.2%. Major adverse limb event (MALE)–free rate was 21.5% at 5 years. Revascularization to a distal target vessel was an independent positive predictive risk factor for a lower limb salvage rate and lower primary patency rate. Dyslipidemia was related to a lower limb salvage rate and represents a risk factor involved in MALEs. Conclusions Although arterial allografts seem to represent a suboptimal alternative, some selected patients could beneficiate from them. Five-year results are disappointing, and more studies are required to know other predictive factors for better selection of patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|