RESUMEN
AIM: Analysis of risk factors for the outcome of arterial embolism of the extremities (EE). METHODS: Between 1999 and 2003, all patients (n=200) with an EE diagnosed in various departments of the hospital were recruited and analysed retrospectively (single center study). Exclusion criteria were isolated digital emboli, iatrogenic emboli and arterial thromboses. For statistical analysis was used the multivariate nominal regression. RESULTS: There were 138 (69%) leg, and 62 (31%) arm, emboli. Preoperative angiography was performed in 88 patients; a total of 119 (59.5%) cases of incomplete ischemia (leg n=69, arm n=50) were seen. The most common cause of the embolism (73%) was atrial fibrillation (AF). One hundred and seventhyt four patients (87%) were treated by primary surgery. The major amputation rate (lower limb) was 4.3%. Additional arterial emboli were seen in 14 (7%). The mortality rate was 13% (upper extremity embolism 4.8%; lower extremity embolism 16.7%; P=0.021). After discharge, 32.2% of the patients received oral anticoagulation, and 37.9% antiplatelet therapy. The statistical analysis identified postoperative cerebral/visceral thromboembolism as independent risk factor for mortality. CONCLUSIONS: The main risk factor for EE is AF. Hospital mortality is determined by comorbidity and cerebral or visceral embolism. For this reason, effective oral anticoagulation is required, but is possible in only one-third of the patients after discharge.
Asunto(s)
Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/terapia , Extremidades/irrigación sanguínea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/estadística & datos numéricos , Anticoagulantes/uso terapéutico , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/mortalidad , Arteriopatías Oclusivas/patología , Femenino , Alemania/epidemiología , Mortalidad Hospitalaria , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To investigate the intraluminal and extraluminal healing behaviour of a new metallic silver coated, gelatine impregnated vascular graft. DESIGN: Comparative animal experimental investigation with randomisation of the animals to control and experimental groups. MATERIAL AND METHODS: 24 pigs were assigned to two control and two experimental groups. The prostheses were interposed in the pigs' infrarenal aorta. For the evaluation, macroscopic, histological and immunohistochemical criteria were applied. RESULTS: The macroscopic evaluation after explantation of the prosthesis revealed similar healing characteristics in the control and experimental groups. The microscopic determination of neo-intimal thickness showed no significant differences between the groups; nor did the immunohistochemical investigations show any significant difference between the control group and the silver-coated prosthesis group. CONCLUSIONS: No disadvantage of the silver coating in terms of healing and graft patency was found. A possible advantage in terms of the antibacterial effect of the silver coating must be investigated in the clinical setting.
Asunto(s)
Aorta Abdominal/cirugía , Prótesis Vascular , Materiales Biocompatibles Revestidos , Gelatina , Poliésteres , Plata , Animales , Aorta Abdominal/patología , Biomarcadores/análisis , Oclusión de Injerto Vascular/patología , Vigilancia de Productos Comercializados , Diseño de Prótesis , Porcinos , Cicatrización de Heridas/fisiologíaRESUMEN
Besides inflammation, specific immune responses are seen also after implantation of biomaterials. The aim was to investigate the humoral response to bovine collagen type I following implantation of various polyester (Dacron) prostheses into pigs. In 24 randomized pigs, the infrarenal aorta was replaced with a segment of collagen-impregnated, woven polyester prosthesis of low, medium, or high porosity. IgG antibodies were detected by immunoassay using native and denatured collagen type I as a target for blood samples taken on day 1 (implantation), 10, 17, 24, 62, and 116. As generally observed, antibodies to native and denatured collagen are of low titer and were significantly correlated with enhanced binding to the denatured form (p < 0.001). The highest overall antibody prevalence to native and denatured collagen was obtained on day 116 with 68% and on day 62 with 59%, respectively. Prostheses with high porosity induced an early immune response on day 10; those with low and medium porosity induced the highest antibody levels later after 2 months. Collagen antibodies neither correlated with serum IgG contents nor with antibodies to the prosthesis polyester matrix. Thus, humoral immune response against implant components may provide a further parameter in describing biocompatibility but also a potential marker that may facilitate monitoring of individual perigraft reaction.