Journal «Angiology and Vascular Surgery» • 

1999 • VOLUME 5 • №4

TWENTY YEARS OF EXPERIENCE WITH THE USE OF DURA MATER ENCEPHALI IN SURGERY OF THE AORTA AND GREAT VESSELS

B.A. Korolev, M.Yu. Averyanov, Ye.A. Yeliseev, Yu.A. Averyanov
Specialized Cardiosurgical Clinical Hospital, Chair of Hospital Surgery, Nizhni Novgorod State Medical Academy,
Nizhni Novgorod, Russia

The authors summarize many years of experience with the use of the conserved dura mater encephali in reconstructive surgery of the aorta and arteries. Altogether 1078 patients with occlusive vascular diseases of different sites were operated on. 1238 grafts were implanted. Lateral plasty over the length of 2 to 19 cm was accomplished in 1072 cases. Six patients underwent replacement of the arterial segment by the sagittal sine. Of 1040 patients discharged from hospital, the positive results were recorded in 971, which accounted for 93.4%. The postoperative death rate was 3.5% (38 patients). Analysis of the immediate results has revealed that an outcome of operation depended on a number of factors. Particularly, the percentage of unsatisfactory outcomes in stage III-IV ischemia excceded the given index almost ninefold in patients operated on in a stage of disease subcompensation (18.4% and 2.1%, respectively). None of 158 patients at high risk for infectious complications developed graft rejection, thrombosis, bleeding or sepsis. Analysis of the long-term results was made in 683 patients within 12 months to 19 years. As shown by the studies, the percentage of thromboses during the first postoperative year differed negligibly from the incidence of thromboses in the early postoperative period. This confirms the high plastic properties of allografts. The incidence of restenoses increased from the 5th year after intervention, which stemmed from atherosclerosis progression. Investigation of the causes of reocclusions allowed to establish that arterial patency in the reconstructed area depended on the hemodynamic conditions in the involved zone and the rate of the underlying disease progression. According to the data supplied by duplex scanning, no graft calcification or formation of complicated plaques on its basis were recorded. Angiographic and ultrasound examinations failed to identify any areas of ectasia or aneurysmal expansion of the grafts.The best long-term results were obtained in patients with circulatory subcompensation (53%) whereas in stage III-IV disease, the curve of the time course of positive outcomes had a more vertical character and the percentage of positive results did not exceed 25.0.

KEY WORDS: dura mater encephali, surgery of the aorta and great vessels.

P. 10-19

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