Postoperative Anticoagulation in Vascular Reconstructions Associated with Malignancies

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Graft Patency Studies

Background:

• Malignant neoplasms rarely invade truncal arteries and veins, posing surgical challenges.
• Re-establishing blood flow after vessel resection involves debated choices between prosthetic and autologous grafts.
• Conflicting patency results exist between studies comparing prosthetic and autologous vascular grafts.

Purpose of the Study:

• To compare the patency outcomes of vascular reconstructions using autologous versus prosthetic replacement grafts in surgical oncology.
• To evaluate graft performance under a standardized antithrombotic protocol implemented since 1997.

Main Methods:

• Retrospective analysis of 181 vascular reconstructions in 117 patients (1997-2020) undergoing resection of malignancies.
• Comparison of graft patency between prosthetic and autologous interposition grafts.
• Stratification of procedures by body segment: head and neck, thorax, abdomen, and extremities.

Main Results:

• Overall survival at 24 and 60 months was 53.2% and 38.1%, respectively.
• No significant difference in arterial patency between autologous and synthetic grafts (P=0.41).
• A trend towards lower venous patency with synthetic grafts (P=0.062).
• Significantly higher patency for both arterial and venous reconstructions in extremities using autologous grafts.

Conclusions:

• Autologous grafts demonstrate potentially superior long-term patency over prosthetic grafts in vascular reconstructions for extremity malignancies.
• The observed outcomes were achieved utilizing a standardized post-operative anticoagulation regimen.