title: Cryopreserved arterial allograft reconstruction for infected peripheral bypass.
abstract: Infection of peripheral bypass is a very severe complication associated to a high rate of morbimortality. The aim of this study was to prospectively evaluate cryopreserved arterial allografts (CAAs) performances in the treatment of this complication. Between April 1996 and June 2008, we prospectively collected data from patients presenting with major infections of peripheral bypasses who benefited from a CAA reconstruction in association with the excision of the infected bypass. CAA were taken from multi-organ donors and frozen at -80 °C. CAA mean conservation time was 115 days (±132). Over this 12-year study, 36 patients (31 men, five women, mean age = 68) benefited from CAA reconstruction for major infections of peripheral bypasses. Eighteen patients (50%) had a septic syndrome, five patients (14%) had an acute ischemia at the reconstruction time, and 12 patients (33%) had an anastomotic rupture. Emergency CAA reconstruction was performed on seven patients (19%). There were no perioperative deaths and no early amputations. Patient follow-up was complete, with a mean 42 -month duration (range, 3-116). There were no persisting or recurring infections. During the follow-up, 10 patients benefited from revision, excision, or replacement of the CAA and fifteen patients died from causes nonrelated to the initial infection. The cumulative rate of limb salvage was 87% at 3 years. Primary and secondary cumulative patency rates were 57% and 78% at 3 years, respectively. CAA reconstruction in association with infected bypass excision is an effective treatment for peripheral bypass major infections. Our results prompt us to go on with CAA reconstructions for this type of indication.
authors.affiliation: Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat-Claude Bernard, Université Denis Diderot Paris, Paris, France. castier@bch.aphp.fr
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Nikos
authors.initials: N
authors.lastname: Paraskevas
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Maury
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karsenti
authors.forename: Olivier
authors.initials: O
authors.lastname: Cerceau
authors.forename: Anne Fiailaire
authors.initials: AF
authors.lastname: Legendre
authors.forename: Alain
authors.initials: A
authors.lastname: Duprey
authors.forename: Pierre
authors.initials: P
authors.lastname: Cerceau
authors.forename: Fady
authors.initials: F
authors.lastname: Francis
authors.forename: Guy
authors.initials: G
authors.lastname: Leseche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D015925:Cryopreservation; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013530:Surgical Wound Infection / Q000382:microbiology / Q000601:surgery*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects*; D014654:Vascular Patency