vascular graft Dotaz Zobrazit nápovědu
INTRODUCTION: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. METHODS: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. RESULTS: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). CONCLUSIONS: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.
- Klíčová slova
- antibiotics, graft patency, silver-impregnated vascular graft, vascular graft infection,
- Publikační typ
- časopisecké články MeSH
PURPOSE: The purpose of this paper is to assess a long-term outcome of allogenous vein grafts (ALVG) as vascular access for hemodialysis. MATERIALS AND METHODS: For nearly eight years (between 9/2002 and 9/2011) a total of 78 patients with 112 ALVGs were involved in the study. The register included 46 women and 32 men, mean age 66.1 ± 11.2 years; range 20-88 years. The patient database was retrospectively reviewed and statistical processing was performed. RESULTS: Almost all ALVGs were treated by PTA or surgically, very often repeatedly. The number of radiologic interventions was 316, the number of surgical procedures 31. Mean follow-up time was 795 days, range 28-3522 days. Thirty-five patients died of unrelated causes, nineteen with functional graft, fourteen patients were lost to follow-up. Forty ALVGs failed for various reasons, mostly because of occlusion. Only one patient underwent successful renal transplantation, no patient converted to peritoneal dialysis. Thirty-seven ALVGs remain correctly functioning. Primary patency rates at 6, 12, and 24 months were 81 ± 5%, 63 ± 5%, and 34 ± 2% respectively. Secondary patency rates at 6, 12, and 24 months were 96 ± 2%, 82 ± 4%, and 65 ± 5% respectively. CONCLUSIONS: Allogenous vein grafts, in spite of the high number of necessary radiologic and surgical interventions and reinterventions, show acceptable clinical usability and durability, comparable with other types of prosthetic grafts.
- MeSH
- arteriovenózní zkrat škodlivé účinky metody MeSH
- balónková angioplastika MeSH
- časové faktory MeSH
- cévy - implantace protéz MeSH
- dialýza ledvin * MeSH
- dospělí MeSH
- flebografie MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- okluze cévního štěpu etiologie patofyziologie terapie MeSH
- průchodnost cév MeSH
- registrace MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombóza etiologie patofyziologie terapie MeSH
- vény transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Vascular graft infection in the aortoiliac territory (abdominal VGI) is undoubtedly one of the most serious complications in vascular surgery. The treatment is burdened with high mortality and morbidity rates. In 2020, the Guidelines on the Management of Vascular Graft and Endograft Infections were published by the European Society for Vascular Surgery (ESVS). In the light of these guidelines, we decided to review retrospectively all patients who presented to our institution with abdominal VGI. METHODS: Retrospective observational study of patients presented with abdominal VGI treated in our institution between 20112019 (9 years). The primary goal was to elucidate the rate of vascular graft infection in aortoiliac reconstructions performed between 20112019 and also the mortality rate in the patient cohort operated for this complication. The secondary goals were to evaluate the success rate and the complication rate in different types of reconstructions. RESULTS: In the defined period between 20112019 we performed 363 open aortoiliac reconstructions. During the same period we treated altogether 15 patients with abdominal VGI, whose primary reconstruction was mostly performed before 2011 (11 patients). In our cohort of patients who underwent reconstruction between 20112019 we observed a graft infection only in 4 cases (1.1%). In the group of 15 patients with abdominal VGI, the male gender prevailed (14 patients). The mean age at the time of primary reconstruction was 61 years. Most of our reconstructions were performed for occlusive disease (14 cases). All infected grafts were aortobifemoral (1 unilateral aortofemoral). They were all late infections with an average presentation time of 61 months since the primary reconstruction (15180 months). Early mortality rate was as high as 27% (4 patients) and overall mortality was 40%. The secondary reinfection rate after primary treatment was 33%. CONCLUSION: Treatment of abdominal VGI is still burdened with high mortality and morbidity rates. The current ESVS guidelines provide valuable guidance for the diagnosis and management of VGI. It nevertheless remains obvious that the treatment needs to be tailored individually in a multidisciplinary team environment.
- Klíčová slova
- abdominal aorta, graft, infection,
- MeSH
- aorta abdominalis chirurgie MeSH
- arteria iliaca MeSH
- cévní protézy * škodlivé účinky MeSH
- lidé MeSH
- retrospektivní studie MeSH
- stenty MeSH
- výkony cévní chirurgie * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
AIM: The aim of this study was to evaluate short-term patency of the new prosthetic graft and its structural changes after explantation. METHODS: The study team developed a three-layer conduit composed of a scaffold made from polyester coated with collagen from the inner and outer side with an internal diameter of 6 mm. The conduit was implanted as a bilateral bypass to the carotid artery in 7 sheep and stenosis was created in selected animals. After a period of 161 days, the explants were evaluated as gross and microscopic specimens. RESULTS: The initial flow rate (median ± IQR) in grafts with and without artificial stenosis was 120 ± 79 ml/min and 255 ± 255 ml/min, respectively. Graft occlusion occurred after 99 days in one of 13 conduits (patency rate: 92%). Wall-adherent thrombi occurred only in sharp curvatures in two grafts. Microscopic evaluation showed good engraftment and preserved structure in seven conduits; inflammatory changes with foci of bleeding, necrosis, and disintegration in four conduits; and narrowing of the graft due to thickening of the wall with multifocal separation of the outer layer in two conduits. CONCLUSIONS: This study demonstrates good short-term patency rates of a newly designed three-layer vascular graft even in low-flow conditions in a sheep model.
- MeSH
- arteriae carotides účinky léků MeSH
- cévní protézy MeSH
- cévy - implantace protéz metody MeSH
- kolagen metabolismus MeSH
- okluze cévního štěpu farmakoterapie MeSH
- ovce MeSH
- prospektivní studie MeSH
- protézy - design metody MeSH
- průchodnost cév účinky léků MeSH
- zákroky plastické chirurgie metody MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kolagen MeSH
INTRODUCTION: The aim of this study was to develop a prototype of an artificial blood vessel which has similar mechanical properties to a human saphenous vein graft and to experimentally verify the function of the prosthesis via ovine carotid bypass implantation. MATERIAL AND METHODS: The prototype of an artificial graft prosthesis for low flow was developed and manufactured from a collagenous matrix and reinforcing polyester mesh. We compared the results of both the pressurisation and the mechanical stress evaluation tests of VSM with four types of hybrid vascular graft. The most similar graft (type II) was chosen for the first ovine model implantation. RESULTS: Dominant behavior e.g. mechanical response of VSM graft in plots of circumferential and axial stress during loading is observed in circumferential direction. Average results of used VSM showed area of ideal mechanical response and the properties of artificial blood vessels were fitted into this area. Developed graft remained patent after 161 days of follow up in ovine model. CONCLUSIONS: The mechanical properties of the graft were designed and adjusted to be similar to the behaviour of human saphenous veins. This approach showed promising results and enhanced the final performance of the prosthesis.
OBJECTIVE: Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting.Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. METHODS: Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. RESULTS: The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). CONCLUSION: Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.
- Klíčová slova
- calcium score, graft length, graft morphology, graft patency, sequential graft, target quality,
- MeSH
- anastomóza chirurgická * MeSH
- CT angiografie MeSH
- koronární angiografie MeSH
- koronární bypass * metody škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- okluze cévního štěpu * etiologie patofyziologie MeSH
- průchodnost cév * MeSH
- senioři MeSH
- vena saphena * transplantace diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: Backround. The use of artificial vascular grafts (arteriovenous graft, AVG) is indicated in patients in hemodialysis programs if the subcutaneous venous bed is exhausted or unsuitable for arteriovenous fistula (AVF) creation. The native fistula should be the hemodialysis access of first choice: AVF has better results in terms of function and potential complications. However, the use of AVG is necessary in some patients. In these patients, extensive clinical examination, color duplex sonography and angiography should be performed prior to indication. The technique of graft implantation requires respect for geometric relations for the graft anastomoses to minimize the formation of intimal hyperplasia mainly on the venous anastomosis. The main complications of AVG are stenosis on the venous anastomosis (VAG), causing closure of graft and graft infection. The cumulative function of AVG is 59-90% in the first year and 50-82% in the second year. Arteriovenous graft stenosis leading to thrombosis is a major cause of complications in patients undergoing hemodialysis. The purpose of this review is to summarise current knowledge of the diagnostics and treatment of graft thrombosis and discuss the issue in combination with relevant publications via Pubmed database. CONCLUSION: The most frequent cause of failure of AVG for hemodialysis is stenosis and closure by VAG. AVG closure can be addressed surgically, endovascularly (amenable to thrombectomy by radiological or surgical means) and by hybrid performance.
Chronic hemodialysis therapy required regular entry into the patient's blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.
- Klíčová slova
- Hemodialysis, arteriovenous fistula, arteriovenous graft, hemodialysis vascular access, ultrasonography,
- MeSH
- arteriovenózní zkrat * škodlivé účinky MeSH
- dialýza ledvin MeSH
- duplexní dopplerovská ultrasonografie MeSH
- lidé MeSH
- okluze cévního štěpu diagnostické zobrazování etiologie terapie MeSH
- průchodnost cév MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
We present the case of a 77-year-old male patient who had undergone a bilateral venous aortorenal bypass graft 30 years previously. Thirteen years previously, the patient was shown to have a decrease in renal function, with mild shrinking of both kidneys; additionally, a stenosis was found in the left proximal anastomosis. At the most recent follow-up visit (1 year previously), ultrasound revealed an aneurysm (42 mm in diameter) of the left renal bypass graft; the finding was confirmed by CT angiography. A significant ostial stenosis of the left renal bypass graft was also confirmed. It was decided to place a self-expandable stent-graft into the aneurysm while also attempting to dilate the stenosis. Proximal endoleak after stent-graft placement necessitated the implantation of another, balloon-expandable stent-graft into the bypass graft ostium. Postprocedural angiography and follow-up by CT angiography at 3 months confirmed good patency of the stent-grafts and complete thrombosis of the aneurysmal sac, with preserved kidney perfusion. Renal function remained unaltered, while the hypertension is better controlled.
- MeSH
- aneurysma diagnostické zobrazování etiologie terapie MeSH
- angiografie MeSH
- cévní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- obstrukce renální arterie diagnostické zobrazování etiologie terapie MeSH
- okluze cévního štěpu diagnostické zobrazování etiologie terapie MeSH
- počítačová rentgenová tomografie MeSH
- průchodnost cév MeSH
- senioři MeSH
- stenty * MeSH
- výkony cévní chirurgie škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Vascular graft infection is a rare but serious complication in vascular surgery, associated with high morbidity and mortality. Early diagnosis of vascular graft infection is important for proper and timely surgical and antibiotic treatment that improves the outcome. The tactic and techniques of surgical treatment of vascular graft infection have changed over the last two decades, and this trend can also be observed in our retrospective study. METHODS: We evaluated a group of patients with prosthetic vascular reconstructions performed at the Department of Surgery, University Hospital in Pilsen in the period of 2003-2021 using retrospective analysis. In the analyzed 19-year period, 23 infected vascular grafts were managed out of a total of 2090 performed peripheral bypasses, and 27 infected vascular grafts were managed out of a total set of 1940 central reconstructions. RESULTS: The incidence of peripheral vascular graft infections at our Department of Surgery in the period of 2003-2021 reached 1.1% with the early mortality rate of 8.7%; 1.4% central vascular graft infections occurred in the same time period with 33% early mortality. CONCLUSION: The results of our retrospective study are comparable virtually in all parameters with the experience of other departments. Consistently, our department switched to in situ replacements for explanted vascular grafts and we can confirm good experience with silver impregnated grafts.
- Klíčová slova
- arterial allograft, silver impregnated graft, vascular graft infection,
- MeSH
- cévní protézy škodlivé účinky MeSH
- cévy - implantace protéz * metody MeSH
- infekce spojené s protézou * etiologie chirurgie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- výkony cévní chirurgie škodlivé účinky metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
