In situ reconstruction with cryopreserved arterial allograft in mycotic aneurysms or aortoiliac prosthetic grafts infection: A multi-institutional experience

Objective: Aortic prosthetic graft infection remains a highly fatal surgical complication. Recent studies with cryopreserved allografts in the treatment of vascular graft infection suggest improved clinical outcomes. The purpose of this study was to evaluate the efficacy of cryopreserved aortic allografts in the treatment of infected prosthetic grafts or mycotic aneurysms. Methods: Clinical data of all patients who underwent in situ aortic reconstruction with cryopreserved allografts for either infected aortic prosthetic graft or mycotic aneurysms from 1999 to 2003 were reviewed. Relevant clinical variables and treatment outcomes were analyzed. Results: A total of 18 patients (14 men; overall mean age 62 ± 12 years, range 41-72 years) were identified during this study period. Treatment indications include 12 primary aortic graft infections (67%), four mycotic aneurysms (22%), and two aortoenteric erosions (11%). Transabdominal and thoracoabdominal approaches were used in 14 (78%) and four patients (22%), respectively. Staphylococcus aureus was the most commonly identified organism (n = 11, 61%). Although there was no intraoperative death, the 30-day operative mortality was 17% (3/18). There were nine (50%) non-fatal complications including local wound infection (n = 3), lower extremity deep venous thrombosis (n = 2), amputation (n = 2), and renal failure requiring hemodialysis (n = 2). The average length of their hospital stay was 16.4 ± 7 days. During a mean follow-up period of 8.3 months, reoperation for allograft revision was necessary in one patient due to graft thrombosis. The overall treatment mortality rate was 22% (4/18). Conclusion: In situ aortic reconstruction with cryopreserved allografts is an acceptable treatment modality in patients with infected aortic prosthetic graft or mycotic aneurysms. Our study showed that mid-term graft-related complications such as reinfection or aneurysmal degeneration remained uncommon.