[Indications for the use of vascular homografts]

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 short-term 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 case 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.