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Results of Cryopreserved Arterial Allografts to Treat Infections of Peripheral Bypasses
e2 Abstracts accepted for presentation during the 31st Annual Meeting of the French Society for Vascular and Endovascular Surgery, Grenoble, June 24-27, 2016, President: Pr. Jean-Luc Magne
WILL THROMBOSED LOWER EXTREMITIES BYPASSES TREATED WITH INTRAARTERIAL IN SITU FIBRINOLYSIS KEEP A GOOD SECONDARY PATENCY? Tchala Kassegne, Myriam Ammi, Francine Thouveny, Micka€el Daligault, Xavier Papon, Bernard Enon, and Jean Picquet
Annals of Vascular Surgery
RESULTS OF CRYOPRESERVED ARTERIAL ALLOGRAFTS TO TREAT INFECTIONS OF PERIPHERAL BYPASSES Joseph Touma, Mahine Kashi, Nadia Oubaya, Frederic Cochennec, Eric Allaire, Jean Marzelle, Jean-Pierre Becquemin, and Pascal Desgranges
CHU d’Angers, Angers, France.
Services de chirurgie vasculaire et de sante publique et d’epidemiologie, CHU Henri Mondor, Creteil, France.
Objectives: Despite the advent of transluminal angioplasty, the conventional bypass surgery still has a place of choice for the treatment of TASC IV occlusive lesions of the lower extremities. In the event of acute thrombosis, these bypasses can be reopened by in situ fibrinolysis (ISF). The aim of this study was to evaluate the secondary patency of thrombosed and fibrinolysed bypasses. Materials and Methods: We included retrospectively all the patients hospitalized for thromboses of bypasses of the lower extremities treated by in situ fibrinolysis with urokinase between 2004 and 2013. ISF was indicated in the event of a recent thrombosis (<3 weeks) responsible for an acute ischemia without sensitive or motor deficit, in the absence of general contraindications. It was carried out according to the same protocol with biological controls every six hours and angiographic controls daily. Patency was calculated according to Kaplan-Meier. Results: 143 patients were included. 80% were men with a 66 ± 13 years mean age, hospitalized for the recent thrombosis of 185 bypasses, including 71 proximal and 127 infrainguinal bypasses (13 mixed revascularizations), with a venous or prosthetic bypass in 63 and 144 cases respectively (22 composite bypasses). ISF was effective in 74.6% of the cases (n¼138). An objective cause of thrombosis was found in 85% of the cases (n¼117). An etiological surgical treatment was carried out in 58% of the cases (n¼80), for 43 distal anastomotic stenoses (31% of the efficient the 138 efficient ISF) and for the atheromatous evolution of the distal bed in 37 cases (27%). The average follow-up of the patients after the treatment of obstructions was 70 ± 39 months. The one year and five years global secondary patency of these bypasses objectified by ultrasound was 58.7% and 32.4%. For proximal bypasses, it was 68.3% and 50.3%, and for infra-inguinal bypasses it was 48.3% and 21.5%. The difference was significant between these two sub-groups (p¼0.002). Using multivariate analysis, the below the knee location of the distal anastomosis was the only independent factor (p¼0.023) influencing secondary patency. Conclusion: The thrombosis of a bypass is a major event. ISF allows desobstruction and the etiologic treatment of thrombosis in many cases. These bypasses have however a poor secondary patency particularly in presence of a below the knee anastomosis, which justifies a close surveillance of the patients.
Objectives: The use of cryopreserved allografts to treat vascular infections is discussed. In aortic position, the high rate of general complications is a confusing factor for the evaluation of the complications specific to the graft. The objective of our study was to evaluate the results of cryopreserved arterial allografts in the infections of peripheral bypasses, with a focus on the specific complications of the graft. Materials and Methods: The patients presenting the infection of a peripheral bypass between February 2004 and March 2014 for which an arterial allograft was implanted were included. The socio-demographic and medical data, the operative indication, the perioperative events, the bacteriology, the protocol of cryopreservation and the follow-up were collected retrospectively. Survival without a complication specific of the graft (thrombosis rupture) and without reinfection and amputation were analyzed by Kaplan-Meier curves and the factors associated with a survival without any specific complication was evaluated with a univariate Cox model. Results: On the whole, 31 patients (83.9% men), with a mean age of 67.2 ± 11.3 years, had the implantation of a cryopreserved allograft for a peripheral bypass infection. Twenty-nine (93.5%) were prosthetic, and two (6.5%) were venous. Eleven patients (35.5%) were operated in urgency. The median follow-up was 9.3 months. Early mortality was 6.7% person-months. There was neither early thrombosis nor amputation. Two early ruptures of allografts and three early reinfections were observed. The global death rate was of 14.1 per 100 person-years. Two late ruptures, six late occlusions and three late reinfections occurred. Seven patients had a late amputation. The median time of survival without specific complication of the graft was 35.4 months. The median time of survival without amputation was 35.4 months. The rate of reinfection was 14.6 per 100 person-years. The univariate analysis of survival made it possible to identify the initial Rutherford stage as a predictive factor of the occurrence of a complication related to the graft (OR ¼ 4.19 [1.06-16.51]. Conclusion: Cryopreserved allografts are burdened with a high rate of complications. Their clinical resistance to infection was not shown in our experience. The use of any autologous venous material remains the first choice in this context.
http://dx.doi.org/10.1016/j.avsg.2016.07.005
http://dx.doi.org/10.1016/j.avsg.2016.07.006
WILL THROMBOSED LOWER EXTREMITIES BYPASSES TREATED WITH INTRAARTERIAL IN SITU FIBRINOLYSIS KEEP A GOOD SECONDARY PATENCY? Tchala Kassegne, Myriam Ammi, Francine Thouveny, Micka€el Daligault, Xavier Papon, Bernard Enon, and Jean Picquet
Annals of Vascular Surgery
RESULTS OF CRYOPRESERVED ARTERIAL ALLOGRAFTS TO TREAT INFECTIONS OF PERIPHERAL BYPASSES Joseph Touma, Mahine Kashi, Nadia Oubaya, Frederic Cochennec, Eric Allaire, Jean Marzelle, Jean-Pierre Becquemin, and Pascal Desgranges
CHU d’Angers, Angers, France.
Services de chirurgie vasculaire et de sante publique et d’epidemiologie, CHU Henri Mondor, Creteil, France.
Objectives: Despite the advent of transluminal angioplasty, the conventional bypass surgery still has a place of choice for the treatment of TASC IV occlusive lesions of the lower extremities. In the event of acute thrombosis, these bypasses can be reopened by in situ fibrinolysis (ISF). The aim of this study was to evaluate the secondary patency of thrombosed and fibrinolysed bypasses. Materials and Methods: We included retrospectively all the patients hospitalized for thromboses of bypasses of the lower extremities treated by in situ fibrinolysis with urokinase between 2004 and 2013. ISF was indicated in the event of a recent thrombosis (<3 weeks) responsible for an acute ischemia without sensitive or motor deficit, in the absence of general contraindications. It was carried out according to the same protocol with biological controls every six hours and angiographic controls daily. Patency was calculated according to Kaplan-Meier. Results: 143 patients were included. 80% were men with a 66 ± 13 years mean age, hospitalized for the recent thrombosis of 185 bypasses, including 71 proximal and 127 infrainguinal bypasses (13 mixed revascularizations), with a venous or prosthetic bypass in 63 and 144 cases respectively (22 composite bypasses). ISF was effective in 74.6% of the cases (n¼138). An objective cause of thrombosis was found in 85% of the cases (n¼117). An etiological surgical treatment was carried out in 58% of the cases (n¼80), for 43 distal anastomotic stenoses (31% of the efficient the 138 efficient ISF) and for the atheromatous evolution of the distal bed in 37 cases (27%). The average follow-up of the patients after the treatment of obstructions was 70 ± 39 months. The one year and five years global secondary patency of these bypasses objectified by ultrasound was 58.7% and 32.4%. For proximal bypasses, it was 68.3% and 50.3%, and for infra-inguinal bypasses it was 48.3% and 21.5%. The difference was significant between these two sub-groups (p¼0.002). Using multivariate analysis, the below the knee location of the distal anastomosis was the only independent factor (p¼0.023) influencing secondary patency. Conclusion: The thrombosis of a bypass is a major event. ISF allows desobstruction and the etiologic treatment of thrombosis in many cases. These bypasses have however a poor secondary patency particularly in presence of a below the knee anastomosis, which justifies a close surveillance of the patients.
Objectives: The use of cryopreserved allografts to treat vascular infections is discussed. In aortic position, the high rate of general complications is a confusing factor for the evaluation of the complications specific to the graft. The objective of our study was to evaluate the results of cryopreserved arterial allografts in the infections of peripheral bypasses, with a focus on the specific complications of the graft. Materials and Methods: The patients presenting the infection of a peripheral bypass between February 2004 and March 2014 for which an arterial allograft was implanted were included. The socio-demographic and medical data, the operative indication, the perioperative events, the bacteriology, the protocol of cryopreservation and the follow-up were collected retrospectively. Survival without a complication specific of the graft (thrombosis rupture) and without reinfection and amputation were analyzed by Kaplan-Meier curves and the factors associated with a survival without any specific complication was evaluated with a univariate Cox model. Results: On the whole, 31 patients (83.9% men), with a mean age of 67.2 ± 11.3 years, had the implantation of a cryopreserved allograft for a peripheral bypass infection. Twenty-nine (93.5%) were prosthetic, and two (6.5%) were venous. Eleven patients (35.5%) were operated in urgency. The median follow-up was 9.3 months. Early mortality was 6.7% person-months. There was neither early thrombosis nor amputation. Two early ruptures of allografts and three early reinfections were observed. The global death rate was of 14.1 per 100 person-years. Two late ruptures, six late occlusions and three late reinfections occurred. Seven patients had a late amputation. The median time of survival without specific complication of the graft was 35.4 months. The median time of survival without amputation was 35.4 months. The rate of reinfection was 14.6 per 100 person-years. The univariate analysis of survival made it possible to identify the initial Rutherford stage as a predictive factor of the occurrence of a complication related to the graft (OR ¼ 4.19 [1.06-16.51]. Conclusion: Cryopreserved allografts are burdened with a high rate of complications. Their clinical resistance to infection was not shown in our experience. The use of any autologous venous material remains the first choice in this context.
http://dx.doi.org/10.1016/j.avsg.2016.07.005
http://dx.doi.org/10.1016/j.avsg.2016.07.006