Indicazioni all’impiego degli omoinnesti vascolari



Ann. Ital. Chir., LXXII, 2, 2001

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Homografts were first mentioned in scientific literature at the
beginning of the 1900s in articles by Yamanouchi and Carrel
who were the first to demonstrate the possibility of
substituting segments of artery by transplanted homologous
segments of vein. Since then homografts have been considered
a possible surgical treatment for stenotic and aneurysmal
diseases of the aortic-iliac-femoral vasculature. Meanwhile
much research has been carried out in an attempt to perfect
the treatment that the biological prothesis undergoes once
explanted. This treatment is aimed at providing the best
possible conservation of the biological and mechanical
characteristics of the graft while eliminating the highly
antigenic components. The introduction in the 1950s of
synthetic prostheses and their immediately encouraging shortterm
and long-term results, clearly better than those of the
homografts, led to the use of these latter being temporarily
abandoned. They came back into the spotlight some years
later with completely different indications from those for
which they had originally been proposed. The natural
resistance to bacterial colonization makes the homograft an
ideal candidate for treatment of infected prostheses or of
patients at high risk of infection (immunosuppressed
patients). Furthermore the low thrombogenicity and the ease
with which they can be sutured are important advantages
for use in pediatric heart surgery and oncologic surgery in
the treatment of associated vascular lesions.
Nevertheless, large scale use of homografts cannot be
recommended for a variety of reasons:
1) the need for ministerial authority;
2) the need for a tissue bank where the certification and
cryopreservation of the homografts could be carried out;
3) the still unsettled doubts about immunological aspects
associated with homografts.


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