Prosthetic vascular infection complicated or not by aortoenteric fistula: comparison of treatment with and without cryopreserved allograft (homograft).
OBJECTIVE
in patients with vascular prosthesis infection, to compare surgical outcome and long-term results of cryopreserved allograft implantations to conventional surgery.


METHODS
retrospective study.


METHODS
two asynchronous series of 44 [series I: 1980-1994; 8 patients with aortoenteric fistula (AEF)] and 22 (series II: 1994-1997; 4 patients with AEF) patients were treated for prosthesis infection. All patients had prosthesis excision. In series I, there were 4 in situ reparations, 26 extra-anatomic bypass, 13 excision only, and one death at laparotomy. In series II, in situ cryopreserved allografts were implanted in all patients.


RESULTS
operative mortality was 16% in series I and 13.6% in series II. For AEF patients, mortality was 37% in series I and 50% in series II. Among hospital survivors, infection-related late mortality was 13.5% in series I and 5% in series II. For AEF patients, late mortality was 20% in series I and 50% in series II. Incidence of reoperations was 54% in series I and 10.5% in series II (p<0.01). Hospital stay was 47.2+/-26.4 days in series I and 16.6+/-11.5 days in series II (p<0.001).


CONCLUSIONS
compared to conventional treatment, incidence of reoperations and length of hospital stay are significantly decreased after cryopreserved allograft implantation. However, closure of aortic stump and extra-anatomic bypass gives better results for patients with AEF.
Lavigne
J-P
JP
Cardiovascular Surgery Department, University Hospital of Liège, B35 Sart Tilman, 4000 Liège, Belgium.
Postal
A
A
Kolh
P
P
Limet
R
R
D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015925:Cryopreservation; D005260:Female; D005402:Fistula / Q000150:complications / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome