Cryopreserved allograft in the management of native and prosthetic aortic infections 3

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Conference Proceeding

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Publication Title

J Am Coll Surg


INTRODUCTION: Management of patients with mycotic aortic aneurysms and prosthetic aortic graft infections is associated with significant morbidity and mortality. We describe a single-center experience with the use of cryopreserved human allografts for in situ reconstruction of infected aortas and aortic grafts. METHODS: We retrospectively reviewed all patients who underwent implantation of cryopreserved aortic allograft at our tertiary care center from June 2010 to December 2016. Demographic data, preoperative work-up, procedural details, and outcomes were collected. RESULTS: Fifteen patients underwent cryopreserved allograft aortic reconstruction. Nine patients had aortic infection associated with a prosthetic graft, and 6 had primary aortic infections. Of these patients, 1 had involvement of the descending thoracic aorta, 6 of the paravisceral aorta, and 8 of the infrarenal abdominal aorta. Mean follow-up was 18.3 months. One (6.7 %) patient died within 30 days (multisystem organ failure). Postoperative complications included graft thrombosis in 1 (6.7%), reoperation for bleeding in 1 (6.7%), MI in 1 (6.7%), acute kidney injury requiring hemo-dialysis in 3 (20%), paraplegia in 1 (6.7 %), and stroke in 1 (6.7%). During follow-up, 2 patients developed graft stenosis requiring angioplasty, and 1 patient had graft rupture requiring stent placement. At 1 month, 6 months, 1 year, 3 years, and 6 years, estimated survivals were 93%, 78%, 67%, 67%, and 67%, respectively. No patient suffered limb loss. CONCLUSIONS: The management of mycotic aneurysms and infected aortic grafts continues to be challenging. Cryopreserved graft with in situ reconstruction provides a viable alternative for ex-tra-anatomic bypass in the setting of infection.





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