title: Arterial allograft allows in-line reconstruction of prosthetic graft infection with low recurrence rate and mortality.
abstract: Surgical management of infected prosthetic vascular grafts is associated with a significant risk of recurrent infection, limb loss, and mortality. Treatment options include graft excision with extra-anatomic bypass and in-line repair with prosthetic graft, vein, or artery. We hypothesized that in-line reconstruction using cryopreserved arterial allografts would be associated with a lower recurrent infection rate, limb loss, and mortality than other alternatives. We reviewed all cases where adults underwent surgical management of infected prosthetic aortic, iliac, or femoral bypass grafts with cryopreserved arterial allograft at our medical center from 2001 to 2008. Cryopreserved arterial allografts were used in 21 patients. There were nearly equal number of men (n = 11, 52%) and women (n = 10, 48%). The median age was 63 years and median time since cryoartery repair was 4 years. There have been no deaths in the follow-up period. Complications (19%) included colon perforation (n = 1), lower extremity compartment syndrome (n = 1), limb ischemia (n = 1), and reinfection with pseudoaneurysm and subsequent limb amputation (n = 1). These positive findings of low morbidity and absence of mortality in high risk patients have resulted in a shift at our institution to the preferential use of cryopreserved arterial allograft with in-line reconstruction for infected prosthetic grafts.
authors.affiliation: University of California Los Angeles, Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, Los Angeles, California, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vardanian
authors.forename: Anthony
authors.initials: A
authors.lastname: Chau
authors.forename: William
authors.initials: W
authors.lastname: Quinones-Baldrich
authors.forename: Peter E
authors.initials: PE
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D015331:Cohort Studies; D015925:Cryopreservation; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome