Vascular Homograft Procurement

Homograft is a tissue graft obtained from an organism of the same species of the recipient. In vascular surgery homograft is the name used for transplanted cadaveric vascular segments, also called allografts. From the first experiences at the beginning of the 20th century till today, they have been used for many different purposes, thanks mainly to their resistance to infections.They are useful for realizing in situ reconstructions of infected vascular or prosthetic segments, reducing the number of extra-anatomic bypass, restoring the natural direction of blood flow and avoiding long-life antibiotic or antimycotic therapy. But these conduits are also affected by some important disadvantages, due to their poor availability (in fact they are stored in dedicated homograft banks) and their need of a long surgical preparation. Moreover allografts are more expensive than prosthetic grafts, and they undergo to a progressive morphological degeneration linked to a phoenomenon of chronic rejection. These features limit homografts use to few selected cases, such as rare complicated thoracic aorta pathologies and occurrence of complications of conventional surgery (particularly linked to infections) for abdominal aorta. This chapter shows step by step all the process necessary to allograft preparation: harvesting, storing, delivery to the allograft banks and at last to the different hospitals where these homografts are implanted, with a particular attention for the surgical tricks that we have to know to avoid damaging the allograft itself.