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Home > Vascular Annual Meeting^® > SS25. Cryopreserved Venous Allograft: An Alternative...

SS25. Cryopreserved Venous Allograft: An Alternative Conduit for Reconstruction of Infected Prosthetic Aortic Grafts

Jason N. MacTaggart, Thomas S. Monahan, Jade S. Hiramoto, Timothy A.M. Chuter, Darren B. Schneider, Rajabrata Sarkar, Charles M. Eichler, Joe H. Rapp, Michael S. Conte, Linda M. Reilly
University of California San Francisco, San Francisco, CA

OBJECTIVES: To evaluate the performance of cryopreserved superficial femoral vein (cryoSFV) for in-line aortic reconstruction of infected prosthetic aortic grafts (IPAG).

METHODS: Retrospective, single institution review of patients undergoing in-line cryoSFV reconstruction after removal of IPAG. Follow up survival, limb preservation and re-intervention data were available for 85% of patients surviving >30 days.

RESULTS: From 1999 to 2008, 40 patients with IPAG (mean age 68, 65% men, 75% aortic occlusive disease, 43% with aortoenteric fistulas) underwent complete aortic graft excision and in-line aortic reconstruction, with an infrarenal aorta-to-cryoSFV anastomosis in 37 (93%). Thirty-day mortality was 15% (3 cardiac, 3 infectious). During follow-up (mean 30 months) no deaths resulted from the aortic graft infection or its treatment. 1 patient (3%) required amputation. 4/6 early re-interventions were for anastomotic or conduit bleeding (including 2/3 perioperative deaths due to persistent infection). 5/8 late re-interventions were for aneurysmal degeneration of the cryovein (mean interval 32 months and 4/5 involving the femoral conduit segment). Kaplan-Meier 36-month cure rate was 80% and re-intervention-free survival was 68%.

CONCLUSIONS: Cryopreserved superficial femoral vein is a suitable conduit for in-line aortic reconstruction after removal of IPAG. Survival and limb salvage rates rival those reported for all other treatment methods. CryoSFV is more resistant to infection than prosthetic repair, eliminates the complications of autologous vein harvest and is immediately available for use off the shelf. However the conduit demonstrates late aneurysmal degeneration and extended follow-up is needed.

AUTHOR DISCLOSURES: J.N. MacTaggart, None; T.S. Monahan, None; J.S. Hiramoto, None; T.A. Chuter, Cook; D.B. Schneider, Gore, Cook; R. Sarkar, None; C.M. Eichler, None; J.H. Rapp, None; M.S. Conte, None; L.M. Reilly, None.

Figure 1.