Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement

Kóbori, László and Németh, Tibor and Nagy, Péter and Dallos, Gábor and Sótonyi, Péter and Fehérvári, Imre and Nemes, Balázs and Görög, Dénes and Patonai, Attila and Monostory, Katalin and Doros, Attila and Sárváry, Enikő and Fazakas, János and Gerlei, Zsuzsanna and Benkő, Tamás and Piros, László and Járay, Jenő and Jong, Koert (2008) Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement. Acta Veterinaria Hungarica, 56 (3). pp. 411-420. ISSN 0236-6290

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Abstract

Vascular complications are major causes of graft failure in liver transplantation. The use of different vascular grafts is common but the results are controversial. The aim of this study was to create an ‘ideal’ arterial interponate for vascular replacements in the clinical field. An autologous, tubular graft prepared from the posterior rectus fascia sheath was used for iliac artery replacement in dogs for 1, 3, 6 and 12 months. Forty-one grafts were implanted and immunosuppression was used in separate groups. The patency rate was followed by Doppler ultrasound. Thirty-seven grafts remained patent, 2 cases with thrombosis and 2 cases with stenosis occurred. There was no evidence of necrosis or aneurysmatic formation. The histological analysis included conventional light microscopic and immunohistochemical examinations for CD34 and factor VIII. The explanted grafts showed signs of arterialisation, appearance of elastin fibres, and smooth muscle cells after 6 months. Electron microscopy showed intact mitochondrial structures without signs of hypoxia. In conclusion, the autologous graft presents acceptable long-term patency rate. It is easy to handle and the concept of beneficial presence of the anti-clot mesothelium until endothelialisation seems to work. The first clinical use was already reported by our group with more than 2 years survival.

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