Potentials of Using Allografts in Surgical Treatment of Popliteal Artery Aneurysms

Abstract

BACKGROUND: The gold standard in reconstructive surgical operations on the infrainguinal arteries is the autovenous conduit from the great saphenous vein. However, in the absence of a suitable autovein, difficulties are encountered in the selection of a suitable material for reconstruction. The use of a synthetic prosthesis as an alternative in the knee joint region is not always possible, especially in the distal position. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The paper describes two case experiences of using allografts from a deceased donor for the surgical treatment of popliteal artery aneurysms. The cases present their potential for use in emergency clinical situations. In the first case, the patient had previously undergone phlebectomy. In the second case, the saphenous veins of the lower limbs had scattered branches and insufficient diameter for reconstruction.

CONCLUSION: The described cases presented the possible effective use of allografts from a deceased donor in patients with true popliteal artery aneurysms.

Keywords

allograft / vessel transplantation / popliteal artery aneurysm / graft

References

[1] Pokrovskiy AV, editor. Klinicheskaya angiologiya. Moscow: Meditsina; 2004;1:145–7, 180–90. (In Russ).

[2] Покровский А.В., ред. Клиническая ангиология. М.: Медицина; 2004. Т. 1. С. 145–147, 180–190.

[3] Cronenwett JL, Johnston KW. Rutherford’s Vascular Surgery. 8th ed. Elsevier; 2014.

[4] Cronenwett J.L., Johnston K.W. Rutherford’s Vascular Surgery. 8th ed. Elsevier; 2014.

[5] Dawson I, Sie R, van Baalen JM, et al. Asymptomatic popliteal aneurysm: elective operation versus conservative follow-up. British Journal of Surgery. 1994;81(10):1504–7. doi: 10.1002/bjs.1800811035

[6] Dawson I., Sie R., van Baalen J.M., et al. Asymptomatic popliteal aneurysm: elective operation versus conservative follow-up // British Journal of Surgery. 1994. Vol. 81, № 10. P. 1504–1507. doi: 10.1002/bjs.1800811035

[7] Guvendik L, Bloor K, Charlesworth D. Popliteal aneurysm: sinister harbinger of sudden catastrophe. British Journal of Surgery. 1980;67(4): 294–6. doi: 10.1002/bjs.1800670422

[8] Guvendik L., Bloor K., Charlesworth D. Popliteal aneurysm: sinister harbinger of sudden catastrophe // British Journal of Surgery. 1980. Vol. 67, № 4. P. 294–296. doi: 10.1002/bjs.1800670422

[9] Greenhalgh RМ. Vascular and Endovascular Controversies Update — 40 Years of Looking Forward. BIBA Publishing; 2018.

[10] Greenhalgh R.М. Vascular and Endovascular Controversies Update — 40 Years of Looking Forward. BIBA Publishing; 2018.

[11] Edwards WS. Exclusion and saphenous vein bypass of popliteal aneurysms. Surgery, Gynecology & Obstetrics. 1969;128(4):829–30.

[12] Edwards W.S. Exclusion and saphenous vein bypass of popliteal aneurysms // Surgery, Gynecology & Obstetrics. 1969. Vol. 128, № 4. P. 829–830.

[13] Tielliu IFJ, Verhoeven ELG, Zeebregts CJ, et. al. Endovascular treatment of popliteal artery aneurysms: results of a prospective cohort study. Journal of Vascular Surgery. 2005;41(4):561–7. doi: 10.1016/j.jvs.2004.12.055

[14] Tielliu I.F.J., Verhoeven E.L.G., Zeebregts C.J., et. al. Endovascular treatment of popliteal artery aneurysms: results of a prospective cohort study // Journal of Vascular Surgery. 2005. Vol. 41, № 4. P. 561–567. doi: 10.1016/j.jvs.2004.12.055

[15] Woody JD, Makaroun MS. Popliteal artery aneurysms. In: Vascular Surgery. 2003;(Ch 7):57–63. doi: 10.1007/978-1-4471-3870-9_7

[16] Woody J.D., Makaroun M.S. Popliteal artery aneurysms. In: Vascular Surgery. 2003. Ch. 7. P. 57–63. doi: 10.1007/978-1-4471-3870-9_7

[17] Neville RF, Tempesta B, Sidway AN. Tibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch. Journal of Vascular Surgery. 2001;33(2):266–71; discussion 271–2. doi: 10.1067/mva.2001.113131

[18] Neville R.F., Tempesta B., Sidway A.N. Tibial bypass for limb salvage using polytetrafluoroethylene and a distal vein patch // Journal of Vascular Surgery. 2001. Vol. 33, № 2. P: 266–271; discussion 271–272. doi: 10.1067/mva.2001.113131

[19] Pokrovsky AV, Dan VN, Zotikov AE, et al. Long-term outcomes of femoropopliteal bypass above the knee-joint fissure by means of vascular prosthesis "Ecoflon" in patients with atherosclerotic lesions of lower limb arteries. Angiology and Vascular Surgery. 2007;13(2):143–9. (In Russ).

[20] Покровский А.В., Дан В.Н., Зотиков А.Е., и др. Отдалённые результаты бедренно-подколенного шунтирования выше щели коленного сустава протезом «экофлон» у пациентов с атеросклеротическим поражением артерий нижних конечностей // Ангиология и сосудистая хирургия. 2007. Т. 13, № 2. С. 143–149.

[21] Kalinin RE, Suchkov IA, Klimentova EA, et al. Apoptosis in vascular pathology: present and future. I.P. Pavlov Russian Medical Biological Herald. 2020;28(1):79–87. (In Russ). doi: 10.23888/PAVLOVJ202028179-87

[22] Калинин Р.Е., Сучков И.А., Климентова Э.А., и др. Апоптоз в сосудистой патологии: настоящее и будущее // Российский медико- биологический вестник имени академика И.П. Павлова. 2020. Т. 28, № 1. С. 79–87. doi: 10.23888/PAVLOVJ202028179-87

[23] Kalinin RE, Suchkov IA, Pshennikov AS. Correction of endothelial dysfunction as a component in treatment for atherosclerosis obliterans of lower limb arteries. Angiology and Vascular Surgery. 2014;20(3):17–22. (In Russ).

[24] Калинин Р.Е., Сучков И.А., Пшенников А.С. Коррекция эндотелиальной дисфункции как компонент в лечении облитерирующего атеросклероза артерий нижних конечностей // Ангиология и сосудистая хирургия. 2014. Т. 20, № 3. С. 17–22.

[25] Strelnikova EA, Trushkina PYu, Surov IYu, et al. Endothelium in vivo and in vitro. Part 1: histogenesis, structure, cytophysiology and key markers. Sciences of the young (Eruditio Juvenium). 2019;7(3):450–65. (In Russ). doi: 10.23888/ HMJ201973450-465

[26] Стрельникова Е.А., Трушкина П.Ю., Суров И.Ю., и др. Эндотелий in vivo и in vitro. Часть 1: гистогенез, структура, цитофизиология и ключевые маркеры // Наука молодых (Eruditio Juvenium). 2019. Т. 7, № 3. С. 450–465. doi: 10.23888/ HMJ201973450-465

[27] Kalinin RE, Suchkov IA, Mzhavanadze ND, et al. Comparison of cytotoxicity of vascular prostheses in vitro. I.P. Pavlov Russian Medical Biological Herald. 2020;28(2):183–92. (In Russ). doi: 10.23888/PAVLOVJ2020282183-192

[28] Калинин Р.Е., Сучков И.А., Мжаванадзе Н.Д., и др. Сравнение цитотоксичности синтетических сосудистых протезов in vitro // Российский медико-биологический вестник имени академика И.П. Павлова. 2020. Т. 28, № 2. С. 183–192. doi: 10.23888/PAVLOVJ2020282183-192

[29] Lebedev LV, Plotkin LL, Smirnov AD, et al. Protezy krovenosnykh sosudov. 4th ed. Saint–Petersburg: Admiralteystvo; 2001. (In Russ).

[30] Лебедев Л.В., Плоткин Л.Л., Смирнов А.Д., и др. Протезы кровеносных сосудов. 4-е изд. СПб.: Адмиралтейство; 2001.

[31] Mezzetto L, Scorsone L, Pacca R, et al. Treatment of popliteal artery aneurysms by means of cryopreserved homograft. Annuals of Vascular Surgery. 2015;29(6):1090–6. doi: 10.1016/j.avsg.2015.02.007

[32] Mezzetto L., Scorsone L., Pacca R., et al. Treatment of popliteal artery aneurysms by means of cryopreserved homograft // Annuals of Vascular Surgery. 2015. Vol. 29, № 6. P. 1090–1096. doi: 10.1016/j.avsg.2015.02.007

[33] Heinola I, Kantonen I, Mattila I, et al. Cryopreserved Venous Allografts in Supra-inguinal Reconstructions: A Single Centre Experience. European Journal of Vascular and Endovascular Surgery. 2019;58(6):912–9. doi: 10.1016/j.ejvs.2019.06.024

[34] Heinola I., Kantonen I., Mattila I., et al. Cryopreserved Venous Allografts in Supra–inguinal Reconstructions: A Single Centre Experience // European Journal of Vascular and Endovascular Surgery. 2019. Vol. 58, № 6. P. 912–919. doi: 10.1016/j.ejvs.2019.06.024

[35] Podlaha J. Twenty years operating experience for popliteal artery aneurysm. Acta Chirurgica Belgica. 2007;107(5):540–3. doi: 10.1080/00015458.2007.11680118

[36] Podlaha J. Twenty years operating experience for popliteal artery aneurysm // Acta Chirurgica Belgica. 2007. Vol. 107, № 5. P. 540–543. doi: 10.1080/00015458.2007.11680118

[37] Kalinin RE, Suchkov IA, Karpov VV, et al. The First Experience of Using Allografts in Surgery of Main Arteries of Lower Limbs. Russian Sklifosovsky Journal of Emergency Medical Care. 2020;9(3):442–8. (In Russ). doi: 10.23934/2223-9022-2020-9-3-442-448

[38] Калинин Р.Е., Сучков И.А., Карпов В.В., и др. Первый опыт применения аллографтов в хирургии магистральных артерий нижних конечностей // Журнал им. Н.В. Склифосовского Неотложная медицинская помощь. 2020. Т. 9, № 3. С. 442–448. doi: 10.23934/2223-9022-2020-9-3-442-448

[39] Muhamadeev IS, Fried GG, Berezina IA. The evaluation of arterial and venous allografts viablity in vitro depending on the period of preservation. Morphological Newsletter. 2007;(1–2):197–201. (In Russ).

[40] Мухамадеев И.С., Фрейд Г.Г., Березина И.А. Оценка жизнеспособности артериальных и венозных аллографтов in vitro в зависимости от сроков консервации // Морфологические ведомости. 2007. № 1–2. С. 197–201.

[41] Natsional’nyye rekomendatsii po diagnostike i lecheniyu zabolevaniy arteriy nizhnikh konechnostey. Moscow; 2019. Available at: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf. Accessed: 2021 July 20. (In Russ).

[42] Национальные рекомендации по диагностике и лечению заболеваний артерий нижних конечностей. М.; 2019. Доступно по: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf. Ссылка активна на 20.07.2021.

[43] Randon C, Jacobs B, de Ryck F, et al. Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage. Journal of Vascular Surgery. 2010;51(4):869–77. doi: 10.1016/j.jvs.2009.11.062

[44] Randon C., Jacobs B., de Ryck F., et al. Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage // Journal of Vascular Surgery. 2010. Vol. 51, № 4. P. 869–877. doi: 10.1016/j.jvs.2009.11.062