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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term experience in autologous in vitro endothelialization of infrainguinal ePTFE grafts
Journal of Vascular Surgery, Volume 49, No. 2, Year 2009
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Description
Objective: Based on a previous randomized study showing significantly superior patency rates for in vitro endothelialized expanded polytetrafluoroethylene (ePTFE) grafts we investigated whether it was feasible for a nontertiary institution to offer autologous in vitro endothelialization to all elective infrainguinal bypass patients who had no suitable saphenous vein available. Methods: Over a period of 15 years, 310 out of 318 consecutive nonacute patients (age 64.7 ± 8.6) received 341 endothelialized ePTFE grafts (308 femoropopliteal: 153 above knee [AK] and 155 below knee [BK] and 33 femorodistal). Autologous endothelial cells were harvested from short segments (3.9 ± 1.1 cm) of subcutaneous veins (80% cephalic, 11% basilic, 2% external jugular, and 7% saphenous) and grown to mass cultures within 18.9 ± 4.5 days before being confluently lined onto fibrin glue-coated ePTFE grafts. The graft diameter was 6 mm (64%) or 7 mm (36%). The overall procedure-related delay for graft implantation was 27.6 + 7.8 days. Growth failure prevented 2.5% of patients from receiving an endothelialized graft. The mean observation period was 9.6 years. Primary patencies were obtained from Kaplan-Meier survivorship functions. Explants for morphological analysis were obtained from eight patients. Results: The overall primary patency rate of femoropopliteal grafts was 69% at 5 years (68% [AK] vs 71% [BK]) and 61% at 10 years (59% [AK] vs 64% [BK]). Primary patency of 7 mm vs 6 mm grafts was 78%/62% at 5 years and 71%/55% at 10 years. The difference between the two groups was statistically significant (log rank test P = .023; Breslow test P = .017). Stage I vs II/III patients showed 5-year patencies of 67% vs 73% (N.S.) and 10-year patencies of 61%% vs 53% (N.S.). The primary patency of femorodistal grafts was 52% at 5 years and 36% at 10 years. The limb salvage rate was 94% (fempop) vs 86% (femdistal) at 5 years and 89% vs 71% at 10 years. All retrieved samples showed the presence of an endothelium after 38.9 ± 17.8 months. Conclusion: Autologous in vitro endothelialization was shown to be a feasible routine procedure at a nontertiary hospital. Explants confirmed the presence of an endothelium years after implantation while the primary patency in the particularly challenging subgroup of patients without a suitable saphenous vein resembles that of vein grafts. © 2009 The Society for Vascular Surgery.
Authors & Co-Authors
Deutsch, Manfred
Austria, Vienna
Hospital Hietzing
Meinhart, Johann G.
Austria, Vienna
Hospital Hietzing
Zilla, Peter P.
South Africa, Observatory
Groote Schuur Hospital
Howanietz, Norbert
Austria, Vienna
Hospital Hietzing
Gorlitzer, Michael
Austria, Vienna
Hospital Hietzing
Froeschl, Alexander
Austria, Vienna
Hospital Hietzing
Stuempflen, Andreas
Austria, Vienna
Hospital Hietzing
Bezuidenhout, Deon
South Africa, Observatory
Groote Schuur Hospital
Grabenwoeger, Martin
Austria, Vienna
Hospital Hietzing
Statistics
Citations: 172
Authors: 9
Affiliations: 2
Identifiers
Doi:
10.1016/j.jvs.2008.08.101
ISSN:
07415214
Research Areas
Health System And Policy