Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry.
OBJECTIVE
Aortic reconstructions for primary graft infection (PGI), mycotic aneurysm (MA), and aortic graft-enteric erosion (AEE) bear high morbidity and mortality rates, and current treatment options are not ideal. Cryopreserved grafts have been implanted successfully in infected fields and may be suitable for abdominal aortic reconstructions. Registry data from several institutions were compiled to examine results of cryopreserved aortic allograft (CAA) placement.


METHODS
The experience of 31 institutions was reviewed for CAAs inserted from March 4, 1999, to August 23, 2001. Indications for CAA, organisms, mortality, and complications were identified.


RESULTS
Fifty-six patients, 43 men and 13 women, with a mean age of 66 years (range, 44 to 90 years) had in situ aortic replacement with CAA. Indications for CAA placement were PGI in 43 patients (77%), MA in seven (14%), AEE in four (7%), and aortic reconstruction with concomitant bowel resection in two (4%). Infectious organisms were identified in 33 patients (59%); the most frequent organism was Staphylococcus aureus in 17 (52%). Thirty-one patients (55%) needed an additional cryopreserved segment for reconstruction. The mean follow-up period was 5.3 months (range, 1 to 22 months). One patient died in the operating room, and the 30-day surgical mortality rate was 13% (7/56). Seven additional patients died during the follow-up period, yielding an overall mortality rate of 25% (14 patients). Two patients (4%) had graft-related mortality as the result of hemorrhage from the CAA and persistent infection. Graft-related complications included persistent infection with perianastomotic hemorrhage in five patients (9%), graft limb occlusion in five (9%), and pseudoaneurysm in one (2%). Three patients (5%) needed amputation.


CONCLUSIONS
In situ aortic reconstruction with CAA in infected fields carries a high mortality rate, but most deaths are not the result of allograft failure. However, CAA infection and lethal hemorrhage caused by graft rupture occurs and is concerning. Early reinfection was not reported. Late graft-related complications, such as reinfection, thrombosis, or aneurysmal changes, are unknown. Preliminary data from this registry fail to justify the preferential use of CAA for PGI, MA, or AEE. A multicenter, randomized study is needed to compare results with established techniques.
Noel
Audra A
AA
Division of Vascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. noel.audra@mayo.edu
Gloviczki
Peter
P
Cherry
Kenneth J
KJ
Safi
Hazim
H
Goldstone
Jerry
J
Morasch
Mark D
MD
Johansen
Kaj H
KH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001012:Aorta, Abdominal / Q000382:microbiology / Q000601:surgery*; D001018:Aortic Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D015925:Cryopreservation; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States