Cryopreserved allograft in the management of native and prosthetic aortic infections 3.
Masabni K, Balraj P, Liang L, Shepard AD, Nypaver T, Weaver M, Kabbani L. Cryopreserved allograft in the management of native and prosthetic aortic infections 3.. J Am Coll Surg 2017; 225(4):S216.
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.