Aortoiliac reconstruction in infants and toddlers: replacement with decellularized branched pulmonary artery allograft.
BACKGROUND
Aortic reconstruction in infants and small children has been reported with Dacron or polytef prosthetic material, hypogastric artery autograft, and saphenous vein autograft. In children, synthetic grafts are limited by a concern for late infection and a lack of potential growth. Available autogenous vessels have a limited length and diameter. Conventional allografts have not been durable. When the entire infrarenal aorta and aortoiliac bifurcation must be replaced, none of the historic options are optimal.


METHODS
We report 2 cases of infrarenal aorta and aortoiliac bifurcation reconstruction using a new generation of cryopreserved allograft now decellularized for decreased immunogenicity. The branched pulmonary artery allograft is particularly attractive for reconstruction of the aortic bifurcation.


RESULTS
The postoperative course in both cases was uncomplicated. Follow-up with serial abdominal duplex ultrasound has shown no evidence of graft stenosis or calcification at 29 and 32 months, respectively.


CONCLUSIONS
The use of commercially available, decellularized, and antigen-reduced allograft offers a nonsynthetic option for replacement of the pediatric abdominal aorta. We chose this novel approach in hopes of reducing the lifetime risk for graft infection and maintaining the potential for graft ingrowth by the child.
Meyers
Rebecka L
RL
Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT 84113, USA. rebecka.meyers@hsc.utah.edu
Lowichik
Amy
A
Kraiss
Larry W
LW
Hawkins
John A
JA
D001011:Aorta / Q000473:pathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000151:congenital / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002675:Child, Preschool; D006801:Humans; D007083:Iliac Artery / Q000473:pathology* / Q000601:surgery*; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome