Outcomes of Cryopreserved Allografts for Arterial Reconstruction in Infected and Contaminated Fields
Recommended Citation
Chamseddine H, Kavousi Y, Kabbani L, Weaver M, Nypaver T, Peshkepija A, Lee A, Musili N, Nguyen T, Shepard A. Outcomes of Cryopreserved Allografts for Arterial Reconstruction in Infected and Contaminated Fields. J Vasc Surg 2024; 79(6):e289-e290.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
J Vasc Surg
Abstract
Objectives: Limited literature exists on cryopreserved allograft (CPA) complication rates, specifically in terms of reinfection, aneurysmal degeneration, and rupture. This study aims to assess outcomes of CPA in the setting of infection/contamination. Methods: A retrospective review of all patients in a quaternary medical center who received CPA for arterial reconstruction in the setting of infection/contamination between 2000-2023 was performed. Exclusions included patients receiving CPA for venous reconstruction, dialysis access, or lower extremity bypass surgery for reasons other than infection. Demographics, indications, procedural details, and outcomes were analyzed. Primary outcomes included CPA reinfection, rupture, aneurysmal degeneration, stenosis, and thrombosis. Kaplan-Meier estimates were used for event rate estimation and subgroup comparisons. Results: Seventy-one patients (49 males, 22 females) with mean age of 64 years met inclusion criteria. Indications for CPA included 49 central artery infections (16 primary, 33 secondary) and 22 peripheral artery infections (7 primary, 15 secondary). Positive intraoperative cultures were found in 73% (52/71) of patients. Median follow up was 25.2 months. Thirty-day, 1-year and 5-year survival rates were 91%, 76%, and 54%, respectively. Early (30-day) CPA-related complications were observed in 7% (n = 5) of patients and included graft rupture, anastomotic dehiscence from persistent infection, and graft thrombosis (Table I). One-year CPA-related complications affected 20% (n = 12) of the patients and included graft aneurysmal degeneration, graft rupture, graft stenosis, graft thrombosis, and graft infection (Table I; Fig 1). Ninety percent (17/19) of all graft-related complications occurred within the first postoperative year. Complications were not associated with implant site (central vs peripheral), infection type (primary vs secondary), or type of organism cultured. Freedom from graft-related reintervention at 1 and 5 years was 83% and 80%, respectively. Reinterventions at 1 year included procedures for rupture (3), aneurysmal degeneration (1), anastomotic dehiscence (2), stenosis (2), occlusion (3), and uretero-graft limb fistula (1). Conclusions: Cryopreserved allografts are an acceptable conduit for arterial reconstruction in infected or contaminated fields. Graft reinfection is low at 7%. All three graft ruptures happened within the first year, with causes of rupture attributed to graft degeneration in two patients and infection from a ureteral injury and pancreatitis in one patient. Aneurysmal degeneration occurred in 6% of patients, whereas graft thrombosis and stenosis occurred in 7% and 3% of patients, respectively. This study revealed that the rate of major CPA complications is highest in the first 12 months post implantation. Aggressive early surveillance is mandatory for optimal outcomes when using this graft in contaminated or infected fields. [Formula presented] [Formula presented]
Volume
79
Issue
6
First Page
e289-e290
