Graft Salvage

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Stefan Buchmann - One of the best experts on this subject based on the ideXlab platform.

Bruce A. Perler - One of the best experts on this subject based on the ideXlab platform.

  • Muscle flaps in the management of prosthetic Graft infections
    Perspectives in Vascular Surgery and Endovascular Therapy, 1999
    Co-Authors: Bruce A. Perler
    Abstract:

    It has been estimated that as many as 10,000 patients each year present with vascular Graft infection in the United States. Although prosthetic Graft infection remains a demanding challenge for the surgeon and a potentially devastating complication for the patient, in recent years management options have increased, and the surgical outcome has improved. Although septic involvement of the main body of an aortoiliac/femoral, or the entire extent of an infrainguinal, bypass continues to require complete Graft excision in most cases, among patients with more localized infection there is growing evidence that aggressive local wound care may allow Salvage of all or most of the origi nal conduit. Graft coverage with well-vascularized skeletal muscle represents an innovative refinement of the local management of prosthetic Graft infection, which may not only increase the likelihood of successful Graft Salvage but also allow this local management strategy to be extended to cases that formerly would have required g...

  • Rotational muscle flaps to treat localized prosthetic Graft infection: long-term follow-up.
    Journal of vascular surgery, 1993
    Co-Authors: Bruce A. Perler, Craig A. Vender Kolk, Paul M. Manson, G. Melville Williams
    Abstract:

    Abstract Purpose:  The conventional management of prosthetic Graft infection (PGI), including Graft excision and extraanatomic revascularization, continues to be associated with substantial morbidity. Rotational muscle flap (RMF) closure of the infected wound, with preservation of the Graft, is an alternative, albeit controversial, approach. Methods:  Over the last 7 years, 22, RMF procedures have been performed to close 19 wounds in 18 patients, ranging in age from 39 to 79 (mean 63.7) years, with PGI. Twenty-one Grafts constructed of Dacron (13) or polytetrafluoroethylene (8) were covered in the groin (16), neck (2), or chest (1). The clinical presentations included abscess or purulent drainage in 14 Grafts, hemorrhage in three, and infected false aneurysm in two wounds; positive bacterial culture results were obtained in each case. Results:  There was one (5.6%) operative death. Healing was achieved in the 18 wounds of the 17 operative survivors. No patients have been lost to follow-up. Three (17.6%) of these 17 patients had recurrent infection, including one patient who underwent a secondary RMF procedure with Graft Salvage, one who underwent excision of an occluded Graft, and one who underwent excision and extraanatomic bypass and died. Four other patients died 1 to 6 (mean 3) months after RMF closure with healed wounds. Eleven (92%) of the 12 survivors have healed wounds and intact Grafts with follow-up ranging from 8 to 83 (mean 39) months. For the entire series 15 (88%) of these 17 patients had healed wounds and intact Grafts, with a mean follow-up of 30 months. Conclusions:  These results suggest that RMF procedures are well tolerated and can achieve acceptable long-term Graft Salvage in selected patients with PGI. (J VASC SURG 1993;18:358-65.)

Robert J Porte - One of the best experts on this subject based on the ideXlab platform.

  • long term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation
    Liver Transplantation, 2010
    Co-Authors: Nienke Warnaar, Wojciech G Polak, Koert P De Jong, Marieke T De Boer, Henkjan J Verkade, E Sieders, Paul M J G Peeters, Robert J Porte
    Abstract:

    Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to Salvage the Graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1- and 5-year Graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1- and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term Graft Salvage in about one-third of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation. Liver Transpl 16:847-855, 2010. (C) 2010 AASLD.

  • Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation.
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation S, 2010
    Co-Authors: Nienke Warnaar, W. Polak, Koert P De Jong, Marieke T De Boer, Henkjan J Verkade, E Sieders, Paul M J G Peeters, Robert J Porte
    Abstract:

    Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to Salvage the Graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1- and 5-year Graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1- and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term Graft Salvage in about one-third of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation.

Roderick T Hester - One of the best experts on this subject based on the ideXlab platform.

  • the role of muscle flaps in wound Salvage after vascular Graft infections the emory experience
    Plastic and Reconstructive Surgery, 2006
    Co-Authors: Hisham Seify, Hunter R Moyer, Glyn E Jones, Antonio Busquets, Katherine Brown, Atef A Salam, Albert Losken, John H Culbertson, Roderick T Hester
    Abstract:

    Background: The incidence of prosthetic Graft infection is 1 to 6 percent, and the mortality rate of infected aortoiliac or aortofemoral bypass is 25 to 75 percent. The goal of this study was to report the use of muscle flaps in the management of patients presenting with infected vascular Grafts. Methods: A total of 22 patients required 26 muscle flaps to cover 24 infected vascular Grafts. Muscle flaps were used for local wound control in all patients regardless of the fate of the Graft. The vascular surgeons elected for Graft Salvage in eight of the 24 Grafts. All of the muscle flaps survived. Results: The average time interval between the bypass and infection was 371 days. One-month follow-up revealed an 88 percent Salvage rate, but this decreased to 50 percent during the mean follow-up of 23 months. None of the patients originally managed with a Salvaged Graft lost a limb, and overall, 14 of 22 limbs in this series remained viable (64.0 percent). The mortality rate during the index hospitalization was 9 percent. In this series, suprainguinal Grafts had a higher mortality rate. In addition, infection occurring more than 1 month postoperatively, culture-positive Pseudomonas and methicillin-resistant species, and exposure of the arterial-Graft anastomosis were poor prognostic indicators of Graft preservation. Conclusions: Management of infected vascular Grafts remains a challenging problem. Muscle flap coverage should have a high priority, as the chance of a good outcome is highly favorable in early infections.

Jonas Pogorzelski - One of the best experts on this subject based on the ideXlab platform.

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