Cryopreserved Arterial Allografts in the Treatment of Prosthetic Graft Infections

Gabriel, Marcin; Pukacki, Fryderyk; Dzieciuchowicz, Łukasz; Oszkinis, Grzegorz; Chęciński, Piotr

doi:10.1016/j.ejvs.2004.02.016

Cited by 56 publications

(25 citation statements)

References 26 publications

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“…Cryopreservation agents such as dimethyl sulfoxide (DMSO) have been investigated with the goal of preserving cells and extracellular matrix during freezing [6,7]. The use of cryopreserved allografts in treating infections of major vascular prosthetic or peripheral bypass grafts is an area of great interest to cardiovascular surgeons [5,12,13]. While cryopreservation has benefits for long-term storage and clinical uses, there is complexity involved with the controlled rate freezing process and the application of DMSO.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Mechanical and Biochemical Properties of Aortic Tissue due to Cold Storage

Chow

Zhang

2011

Journal of Surgical Research

112

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Section: Introductionmentioning

confidence: 99%

Changes in the Mechanical and Biochemical Properties of Aortic Tissue due to Cold Storage

Chow

Zhang

2011

Journal of Surgical Research

112

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“…Serological studies report that cryopreserved arterial allografts, which have proven to be effective in the surgical treatment of arterial infections (Gabriel et al 2004;Teebken et al 2004), are immunogenic since they induce a strong and long-lasting donor-specific anti-HLA antibody response in the recipient (Smith et al 1998;Welters et al 2002;Mirelli et al 2005). In most clinical settings, this serological reaction has been implicated in the process of chronic graft rejection; as to the arterial transplant, it is not yet clear whether this anti-HLA class I antibody response could further contribute to the degradation of the arterial homograft and its late clinical failure.…”

Section: Introductionmentioning

confidence: 99%

The “in situ” expression of Human Leukocyte Antigen Class I antigens is not altered by cryopreservation in human arterial allografts

Pasquinelli

Pistillo²,

Ricci

et al. 2006

Cell Tissue Banking

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This study was aimed to establish whether the cryopreservation procedure we currently use in clinics can modify arterial homograft antigenicity. To this purpose, we performed an immunohistochemical study on fresh and cryopreserved human arterial homografts to visualize the expression of HLA class I heavy and light chains "in situ" by using the HC-10 and Namb-1 monoclonal antibodies. Human femoral arteries and thoracic aortas were harvested from 18 heart-beating donors and sampled before and after cryopreservation. Arterial segments were frozen in liquid nitrogen vapors in a controlled rate freezing system. After thawing, samples were processed for routine immunohistochemistry. To standardize immunostaining, flow-cytometry indirect immunofluorescence analysis was performed on HUVEC; immunohistochemistry of human ovarian cortical vessels was performed as an additional positive control. Negative controls were performed by omitting tissue incubation with primary antibodies. HLA-class I antigens were markedly expressed by endothelial cells lining surface intima and adventitial vasa vasorum; a moderate expression was found in medial smooth muscle cells. Except for the surface unreactivity caused by loss of endothelium, results from cryopreserved arterial allografts were strictly comparable to those observed in fresh, unfrozen tissues. These results support the view that cryopreserved arterial allografts are immunogenic as their fresh counterparts; apart from smooth muscle cells which retained a moderate expression of HLA class I antigens following cryopreservation, our study suggests that the highly HC-10 positive endothelial cells we found to line the rich adventitial network of vasa vasorum are expected to be one of the major targets of the serological response in the recipient.

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“…In situ reconstruction methods include rifampin-bonded or silver-coated synthetic vascular grafts, cryopreserved or fresh arterial allografts, and autogenous venous grafts 3,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] ( Figure 4). The selection of a specific conduit must be individualized and is somewhat dependent on the personal experience of the vascular surgeon.…”

Section: Management Of Vgismentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Cryopreserved Arterial Allografts in the Treatment of Prosthetic Graft Infections

Cited by 56 publications

References 26 publications

Changes in the Mechanical and Biochemical Properties of Aortic Tissue due to Cold Storage

Changes in the Mechanical and Biochemical Properties of Aortic Tissue due to Cold Storage

The “in situ” expression of Human Leukocyte Antigen Class I antigens is not altered by cryopreservation in human arterial allografts

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

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