Cryopreserved arterial allografts in the treatment of major vascular infection: A comparison with conventional surgical techniques

Objective: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infe ctions. Methods: Seventy-two patients with mycotic aneurysms (n = 29) or in fected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal a orta (n = 46) were treated with in situ repair and extraanatomic reconstruc tion using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up. Results: The use of cryopreserved arterial allografts was sup erior to conventional surgery in terms of disease-related survival (P = .00 8), disease-related survival free of reoperation (P = .0001), duration of i ntensive care per year of follow-up (median 1 vs II days; range 1 to 42 vs 2 to 120 days; P = .001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P = .002), duration of postoperative antibiotic therapy (2 1 vs 40 days; range 21 to 90 vs 60 to 365 days; P = .002), incidence of com plications (24 % vs 63%; P = .005), and elimination of infection (91% vs 53 %; P = .001), In addition, costs were 40% lon er in the group treated by al lografts (P = .005), Conclusions: The use of cryopreserved arterial allogra fts is a more effective treatment for mycotic aneurysms and infected vascul ar prostheses than conventional surgical techniques.