Arterial reconstruction with cryopreserved human allografts in the setting of infection: A single-center experience with midterm follow-up.
OBJECTIVE
Vascular reconstruction in the setting of primary arterial or prosthetic graft infection is associated with significant morbidity and mortality. Cryopreserved human allografts (CHA) may serve as acceptable alternatives when autogenous or extra-anatomic/in situ prosthetic reconstructions are not possible.


METHODS
Between February 1999 and June 2008, 57 CHAs were placed in 52 patients (average age, 65 years) for abdominal aortic (n = 18) or iliofemoral/femoral-popliteal arterial or prosthetic infections (n = 39). Indications for arterial reconstruction included infected implanted prosthetic material (n = 39), mycotic pseudoaneurysms (n = 14), or intra-abdominal bacterial contamination or wound infection (n = 4). Wide local debridement and culture was followed by allograft interposition, bypass, or extra-anatomic reconstruction. Over a similar time period, 53 non-CHA extra-anatomical prosthetic or in situ autogenous tissue reconstructions were performed in 53 patients (average age, 65 years) for abdominal aortic (n = 18) or iliofemoral and femoral-popliteal (n = 35) prosthetic graft infections. Indications for arterial replacement in all cases included infected implanted prosthetic material.


RESULTS
Thirty-day mortality for all CHA and non-CHA reconstructions was 5.2% and 7.5%, respectively. The 1-year procedure-related mortality for all CHA and non-CHA procedures was 7.0% and 13.2%, respectively. In the CHA cohort, 5 patients required re-exploration for hemorrhage or anastomotic disruption. In midterm CHA follow-up (20 months), there was 1 graft thrombosis, 2 graft stenoses, 1 recurrent ilioenteric fistula, and 1 non-related amputation. The remainder of the CHA reconstructions remained patent without evidence of aneurysmal change or reinfection.


CONCLUSIONS
In the setting of infection, cryopreserved human allograft arterial reconstruction is a viable alternative to traditional methods of vascular reconstruction in patients without available autogenous conduit and when expedient reconstruction is required. In midterm follow-up, cryopreserved allografts appear to be resistant to subsequent reinfection, thrombosis, or aneurysmal dilatation. However, larger patient populations and longer follow-up are needed to determine if arterial reconstruction with CHA is the safest and most durable method of treatment for arterial infections.
Brown
Katherine E
KE
Division of Vascular Surgery, Northwestern University, Chicago, Ill. 60611, USA.
Heyer
Kamaldeep
K
Rodriguez
Heron
H
Eskandari
Mark K
MK
Pearce
William H
WH
Morasch
Mark D
MD
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000382:microbiology / Q000601:surgery; D000785:Aneurysm, Infected / Q000382:microbiology / Q000601:surgery; D001011:Aorta / Q000637:transplantation*; D001018:Aortic Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D015925:Cryopreservation; D003646:Debridement; D005260:Female; D005263:Femoral Artery / Q000637:transplantation*; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D011150:Popliteal Artery / Q000382:microbiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality