title: Technical details with the use of cryopreserved arterial allografts for aortic infection: influence on early and midterm mortality.
abstract: OBJECTIVE
  In situ repair with cryopreserved vascular allografts improves the results in the surgical treatment of aortic infection. This study evaluated the technical pitfalls with the use of allografts that influence early and midterm mortality.
  
  
  METHODS
  Between 1990 and 1999, 49 patients, 21 (43%) with a mycotic aneurysm and 28 (57%) with a prosthetic graft infection of the thoracic and abdominal aorta including pelvic and groin vessels, underwent in situ repair with cryopreserved arterial allografts. Seventeen patients (35%) had aortobronchial, aortoesophageal, or aortoenteric fistulas.
  
  
  RESULTS
  Allograft-related technical problems occurred in eight patients (16%) in this series, and they included: intraoperative rupture caused by allograft friability; allograftenteric fistula from ligated allograft side branches rupturing 8, 18, and 48 months after implantation; anastomotic failure caused by inappropriate mechanical stress; anastomotic stricture after partial replacement of infected prosthetic grafts; allograft failure caused by inappropriate wound drainage; and recurrence of infection after inappropriate duration of antifungal treatment. Seven of the eight technical problems (87%) occurred in the first 10 patients (80%) in this series. There was one technical failure in the remaining 39 patients (2.6%; P =.0002) because of various technical adaptations, such as critical selection of allografts, use of allograft strips supporting large anastomoses, sealing with antibiotic-impregnated fibrin glue, and change in technique of allograft side-branch ligature. The 30-day mortality rate was 6% for the whole series; however, it was 2.6% for last 39 patients, with no recurrence of infection or allograft-related late death.
  
  
  CONCLUSIONS
  In situ repair with cryopreserved arterial allografts achieves excellent early and late results in the treatment of aortic infection. However, distinct allograft-related technical problems had to be overcome to improve the outcome of patients with major vascular infections.
authors.affiliation: Department of Cardiovascular Surgery, Division of Cardiology, University Hospital, Zurich, Switzerland. paul.vogt@chiru.med.uni-giessen.de
authors.forename: Paul R
authors.initials: PR
authors.lastname: Vogt
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-LaRocca
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
authors.forename: Marko I
authors.initials: MI
authors.lastname: Turina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000401:mortality* / Q000601:surgery*; D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery*; D001158:Arteries / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D015925:Cryopreservation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous