• Vascular Annual Meeting
• General Information
• Call for Abstracts
• Exhibitor Information
• Future Meeting Dates
• Past Meeting Information
• Contact Us

Home > Vascular Annual Meeting > brown_arterial_reconstruction

Arterial Reconstruction with Cryopreserved Human Allografts in the Setting of Infection: A Single-Center Experience with Mid-term Follow-up

Katherine E. Brown, Heron Rodriguez, Mark K. Eskandari, Jon S. Matsumura, Melina R. Kibbe, William H. Pearce, Mark D. Morasch.
Northwestern University, Chicago, Ill.

OBJECTIVES: Vascular reconstruction in the setting of primary arterial or prosthetic graft infection is associated with significant morbidity and mortality. Cryopreserved human allografts (CHA) may serve as acceptable alternatives when autogenous or extra-anatomic/in situ prosthetic reconstructions are not possible.

METHODS: From March 1999 to December 2007, 51 CHA were placed in 47 patients (mean age=65) for abdominal aortic (n=21) or iliofemoral arterial infections (n=30). Indications for arterial reconstruction included infected prosthetic grafts (n=17), mycotic aortic or femoral pseudoaneurysms (n=13), infected endoprostheses or stents (n=8), intra-abdominal abscess or wound infection (n=7), and ilioureteral (n=3) and aorto-ilioenteric fistula (n=3). Wide local debridement and culture was followed by allograft interposition, bypass, or extra-anatomic reconstruction. Over a similar time period 54 non-CHA extra-anatomical prosthetic or in-situ venous reconstructions were performed in 54 patients (mean age=70) for abdominal aortic (n=19) or iliofemoral (n=35) arterial of prosthetic graft infections. Indications for arterial replacement included infected aortic or extremity prosthetic grafts (n=40), mycotic aortic or femoral pseudoaneurysms (n=10), infected aortic endografts or arterial stents (n=2), and aortoenteric fistula (n=2). Bacteriology was recorded.

RESULTS: Thirty-day mortality for CHA and non-CHA reconstructions were 2% and 5.6% respectively. In the CHA cohort, 4 patients required early re-exploration for hemorrhage or anastamotic disruption. In long-term CHA follow-up (20 months) there were 2 graft thromboses, 2 graft stenoses, 1 recurrent aortoenteric fistula, and 1 related amputation. The remainder of the CHA reconstructions remain patent without evidence of aneurysmal change or reinfection.

CONCLUSIONS: In the setting of infection, CHA arterial reconstruction is a safe alternative to extra-anatomic prosthetic reconstruction. In mid-term follow-up, allografts appear to be resistant to subsequent re-infection, thrombosis, or aneurysmal dilatation. In patients without available autogenous conduit, when expedient reconstruction is required, CHA serves as a viable alternative to traditional methods of arterial reconstruction.

AUTHOR DISCLOSURES: K.E. Brown, None; H. Rodriguez, None; M.K. Eskandari, None; J.S. Matsumura, None; M.R. Kibbe, None; W.H. Pearce, None; M.D. Morasch, None.