Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta.
OBJECTIVE
This prospective, observational study determined the long-term outcome in patients with abdominal aortic infection (primary or prosthetic graft) who were treated with simultaneous aortic/graft excision and cryopreserved arterial allograft reconstruction.


METHODS
From April 1992 to March 2000, patients with abdominal aortic infection underwent complete or partial excision of the infected aorta/prosthetic graft and cryopreserved arterial allograft reconstruction. Arterial allografts were harvested from multiple organ donors and cryopreserved at -80 degrees C without rate-controlled freezing. The patients were observed for survival, limb salvage, persistence and/or recurrence of infection, and allograft patency. The results were calculated with life-table methods.


RESULTS
During the 8-year study period, 28 consecutive patients (27 men, 1 woman; mean age, 64 years) underwent treatment for abdominal aortic infection (23 graft infections, including 7 graft-enteric fistulas and 5 primary aortic infections). Allograft reconstruction was performed as an emergency procedure in 13 patients (46%). The mean follow-up period was 35.4 months (range, 6-101 months). The overall treatment-related mortality rate was 17.8% (17% for graft infection, 20% for primary aortic infection). The overall 3-year survival was 67%. There was no early or late amputation. There was no persistent or recurrent infection, and none of the patients received long-term (> 3 months) antibiotic therapy. Reoperation for allograft revision, excision, or replacement was necessary in four patients (17%) who were available for examination, with no reoperative perioperative death. The 3-year primary and secondary allograft patency rates were 81% and 96%, respectively.


CONCLUSIONS
Our experience with cryopreserved arterial allograft in the management of abdominal aortic infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complications.
Lesèche
G
G
Service de Chirurgie Vasculaire et Thoracique, Hôpital Beaujon, Clichy, France. guy.leseche@bjn-ap-hop-paris.fr
Castier
Y
Y
Petit
M D
MD
Bertrand
P
P
Kitzis
M
M
Mussot
S
S
Besnard
M
M
Cerceau
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000785:Aneurysm, Infected / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000637:transplantation*; D001014:Aortic Aneurysm / Q000382:microbiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D015925:Cryopreservation / Q000379:methods* / Q000592:standards; D005260:Female; D005263:Femoral Artery / Q000637:transplantation*; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014654:Vascular Patency
D000900:Anti-Bacterial Agents