CRYOPRESERVED ARTERIAL ALLOGRAFTS USED FOR THE TREATMENT OF INFECTED VASCULAR GRAFTS

In this study, 18 patients (17 men and 1 woman; mean age 61 years) wit h a previously infected vascular graft underwent vascular reconstructi on with cryopreserved arterial allografts. Treatment consisted of firs t total (n = 11) or partial removal (n = 7) of infected prosthetic gra fts. Revascularizations were aortoaortic (n = 2), aortobifemoral (n = 8), aortounifemoral (n = 3), femorofemoral (n = 2), iliofemoral (n = 1 ), or femoropopliteal (n = 2) bypasses. Four patients died postoperati vely (22%)-one of septic necrosis of the allograft, one of septic rupt ure of the aortic anastomosis of a previous bypass, one of multiorgan failure, and one of mesenteric infarction. One allograft occluded with in 30 days (5.5%), leading to an above-knee amputation, in the remaini ng patients, routine arteriography or duplex scan showed patent allogr afts. For the 14 survivors, the mean follow-up period was 20 months (r ange: 1-45 months). Two patients died-one of septicemia not related to the allograft, and one of multiple organ failure. Among the 12 surviv ors, 3 patients with non-ABO-compatible allografts developed different types of long-term alterations. One patient had a hemorrhage due to f emoral allograft rupture at 45 days, and two patients had aortic allog rafts dilatation with mural thrombus, necessitating a prosthetic repla cement in one patient. Cryopreserved allografts used for the treatment of infected vascular graft are useful in selected cases, although the y are not totally resistant to infection. Patients should be followed closely to detect significant long-term alterations of the allografts.