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Use of Biosynthetic Prostheses to Treat Bypasses Infections
e24 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
Annals of Vascular Surgery
up. We report our experiment with 132 cryopreserved arterial allografts and discuss the complications observed. Materials and Methods: Between 2000 and 2015, 132 cryopreserved allografts were implanted in 123 patients. These allografts were implanted in 78 patients for a vascular graft infection (group 1), in nine patients for an aorto-digestive fistula (group 2), in nine patients for an infectious arteritis (group 3) and in 27 patients for critical limb ischemia (group 4). Results: Hospital mortality rates were 9.41% (group 1), 30.0% (group 2), 0% (group 3) and 6.89% (group 4), respectively. The average follow-up was 59 months. A reintervention related to a failure of the allograft was necessary in 29.41% (group 1), 45% (group 2), 0% (group 3) and 34.50% (group 4) of the cases, respectively. Five years patency rate were 80% (group 1), 45% (group 2), 100% (group 3) and 24% (group 4), respectively. Survival at five years was 52.85% (group 1), 44.0% (group 2), 90.0% (group 3) and 40.0% (group 4) respectively. Conclusion: Significant mid- and long-term complication rates were observed with arterial allografts. Throughout study, we gradually modified our practice. In particular, we less frequently use allografts for critical limb ischemia. We prefer a segmentary resection for low grade graft infections when possible and to resect the eroded intestine (3rd portion of the duodenum in most cases) with an intestinal anastomosis distant from the vascular repair in the event of aorto-digestive fistula (procedure of uncrossing). The results are in favor of a decrease of perioperative mortality and reintervention rates on allografts.
biosynthetic prosthesis composed of a polyester mesh endoskeleton covered with ovine collagen. It exists in several lengths (20-65 cm), with a 5 to 8 mm diameter. Between January 2015 and December 2015, 31 bypasses were carried out in 31 patients. The principal criteria were the patency and limb salvage rates. The secondary criteria were the reinfectability of the material and the major or minor complications. Results: We operated 18 men (58%), with a 75 years mean age (44-90). The infection was proven in 22 patients (70%) and in nine patients (30%) the use was preventive. Among 31 bypasses, five (16%) were below the knee, seven (22%) were above the knee, 12 (39%) were femoro-crural, five (16%) were iliac and two (6%) were aortic. No death occurred during the 30 postoperative days, and the rate of survival was 89% at one year. The primary patency rates at six and 12 months were 95% and 89% respectively. The limb salvage rate at six and 12 months was 100%. We did not deplore any graft reinfection. Conclusion: This approach has important advantages in comparison with other treatments such as the immediate availability with a reduction of operative time. The Omniflow II prosthesis also has a lower rate of reinfection compared to traditional prostheses. It could be a new alternative to treat graft infections. Other studies are necessary to evaluate the long-term follow-up.
http://dx.doi.org/10.1016/j.avsg.2016.07.047
THERE IS NO NEED FOR EMBOLIZATION OF THE EFFERENT ARTERIES IN THE TREATMENT OF ISOLATED HYPOGASTRIC ANEURYSMS
USE OF BIOSYNTHETIC PROSTHESES TO TREAT BYPASSES INFECTIONS Bertrand Saint-Lebes, Xavier Berard, Eric Ducasse, Xavier Chaufour, Jean-Pierre Bossavy, and Dominique Midy Service de chirurgie vasculaire, CHU Pellegrin, Bordeaux, and Service de chirurgie vasculaire, CHU Rangueil, Toulouse, France. Objectives: Graft infections after vascular reconstruction are rare but constitute a serious complication with a therapeutic challenge. The initial reference treatment was bypass excision with debridement of infected tissues and possibly treatment of the cause. Then arterial continuity must be restored. The problem arises regarding the choice of the material used for reconstruction. The best usable graft is still debated. A biosynthetic prosthesis recently came into the market. The aim of our study was to analyze the results in patients presenting a proven prosthetic infection or at risk of infection in which prosthetic reconstruction appears risky. Materials and Methods: This was a bicentric exploratory study. We used Omniflow II (LeMaitre Vascular), a
http://dx.doi.org/10.1016/j.avsg.2016.07.048
Jacques Tomasi, Adrien Kaladji, Anne Daoudal, Antoine Maudet, Antoine Lucas, and Alain Cardon Unite de chirurgie vasculaire, CHU de Rennes, Rennes, France.
Objectives: The principle of the endovascular treatment of isolated hypogastric aneurysms (IHA) rests on proximal and distal exclusion of the internal iliac and sacrificing the efferent vessels, with the risk of ischemic complications such as buttock claudication (20-30%) and colic or pelvic ischemia. The aim of this study was to show the safety and the long-term effectiveness of the endovascular treatment without embolization of the efferent vessels. Materials and Methods: This was a monocentric retrospective study including the patients treated by endovascular route for an unruptured IHA between January 2005 and December 2014. All the patients were treated with the intention to maintain the patency of the efferent vessels. The standard procedure was proximal embolization of the iliac intern associated with coverage of the hypogastric ostium with a stentgraft or a covered stent.
Annals of Vascular Surgery
up. We report our experiment with 132 cryopreserved arterial allografts and discuss the complications observed. Materials and Methods: Between 2000 and 2015, 132 cryopreserved allografts were implanted in 123 patients. These allografts were implanted in 78 patients for a vascular graft infection (group 1), in nine patients for an aorto-digestive fistula (group 2), in nine patients for an infectious arteritis (group 3) and in 27 patients for critical limb ischemia (group 4). Results: Hospital mortality rates were 9.41% (group 1), 30.0% (group 2), 0% (group 3) and 6.89% (group 4), respectively. The average follow-up was 59 months. A reintervention related to a failure of the allograft was necessary in 29.41% (group 1), 45% (group 2), 0% (group 3) and 34.50% (group 4) of the cases, respectively. Five years patency rate were 80% (group 1), 45% (group 2), 100% (group 3) and 24% (group 4), respectively. Survival at five years was 52.85% (group 1), 44.0% (group 2), 90.0% (group 3) and 40.0% (group 4) respectively. Conclusion: Significant mid- and long-term complication rates were observed with arterial allografts. Throughout study, we gradually modified our practice. In particular, we less frequently use allografts for critical limb ischemia. We prefer a segmentary resection for low grade graft infections when possible and to resect the eroded intestine (3rd portion of the duodenum in most cases) with an intestinal anastomosis distant from the vascular repair in the event of aorto-digestive fistula (procedure of uncrossing). The results are in favor of a decrease of perioperative mortality and reintervention rates on allografts.
biosynthetic prosthesis composed of a polyester mesh endoskeleton covered with ovine collagen. It exists in several lengths (20-65 cm), with a 5 to 8 mm diameter. Between January 2015 and December 2015, 31 bypasses were carried out in 31 patients. The principal criteria were the patency and limb salvage rates. The secondary criteria were the reinfectability of the material and the major or minor complications. Results: We operated 18 men (58%), with a 75 years mean age (44-90). The infection was proven in 22 patients (70%) and in nine patients (30%) the use was preventive. Among 31 bypasses, five (16%) were below the knee, seven (22%) were above the knee, 12 (39%) were femoro-crural, five (16%) were iliac and two (6%) were aortic. No death occurred during the 30 postoperative days, and the rate of survival was 89% at one year. The primary patency rates at six and 12 months were 95% and 89% respectively. The limb salvage rate at six and 12 months was 100%. We did not deplore any graft reinfection. Conclusion: This approach has important advantages in comparison with other treatments such as the immediate availability with a reduction of operative time. The Omniflow II prosthesis also has a lower rate of reinfection compared to traditional prostheses. It could be a new alternative to treat graft infections. Other studies are necessary to evaluate the long-term follow-up.
http://dx.doi.org/10.1016/j.avsg.2016.07.047
THERE IS NO NEED FOR EMBOLIZATION OF THE EFFERENT ARTERIES IN THE TREATMENT OF ISOLATED HYPOGASTRIC ANEURYSMS
USE OF BIOSYNTHETIC PROSTHESES TO TREAT BYPASSES INFECTIONS Bertrand Saint-Lebes, Xavier Berard, Eric Ducasse, Xavier Chaufour, Jean-Pierre Bossavy, and Dominique Midy Service de chirurgie vasculaire, CHU Pellegrin, Bordeaux, and Service de chirurgie vasculaire, CHU Rangueil, Toulouse, France. Objectives: Graft infections after vascular reconstruction are rare but constitute a serious complication with a therapeutic challenge. The initial reference treatment was bypass excision with debridement of infected tissues and possibly treatment of the cause. Then arterial continuity must be restored. The problem arises regarding the choice of the material used for reconstruction. The best usable graft is still debated. A biosynthetic prosthesis recently came into the market. The aim of our study was to analyze the results in patients presenting a proven prosthetic infection or at risk of infection in which prosthetic reconstruction appears risky. Materials and Methods: This was a bicentric exploratory study. We used Omniflow II (LeMaitre Vascular), a
http://dx.doi.org/10.1016/j.avsg.2016.07.048
Jacques Tomasi, Adrien Kaladji, Anne Daoudal, Antoine Maudet, Antoine Lucas, and Alain Cardon Unite de chirurgie vasculaire, CHU de Rennes, Rennes, France.
Objectives: The principle of the endovascular treatment of isolated hypogastric aneurysms (IHA) rests on proximal and distal exclusion of the internal iliac and sacrificing the efferent vessels, with the risk of ischemic complications such as buttock claudication (20-30%) and colic or pelvic ischemia. The aim of this study was to show the safety and the long-term effectiveness of the endovascular treatment without embolization of the efferent vessels. Materials and Methods: This was a monocentric retrospective study including the patients treated by endovascular route for an unruptured IHA between January 2005 and December 2014. All the patients were treated with the intention to maintain the patency of the efferent vessels. The standard procedure was proximal embolization of the iliac intern associated with coverage of the hypogastric ostium with a stentgraft or a covered stent.