Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta

Purpose. This prospective, observational study determined the long-term out come in patients with abdominal aortic infection (primary or prosthetic gra ft) who were treated with simultaneous aortic/graft excision and cryopreser ved arterial allograft reconstruction. Methods. From April 1992 to March 2000, patients with abdominal aortic infe ction underwent complete or partial excision of the infected aorta/prosthet ic graft and cryopreserved arterial allograft reconstruction. Arterial allo grafts were harvested from multiple organ donors and cryopreserved at -80 d egreesC without rate-controlled freezing. The patients were observed for su rvival, limb salvage, persistence and/or recurrence of infection, and allog raft patency. The results were calculated with life-table methods. Results. During the 8-year study period, 28 consecutive patients (27 men, 1 woman; mean age, 64 years) underwent treatment for abdominal aortic infect ion (23 graft infections, including 7 graft-enteric Fistulas and 5 primary aortic infections). Allograft reconstruction was performed as an emergency procedure in 13 patients (46%). The mean followup period was 35.4 months (r ange, 6-101 months). The overall treatment-related mortality rate was 17.8% (17% for graft infection, 20% for primary aortic infection). The overall 3 -year survival was 67%. There was no early or late amputation. There was no persistent or recurrent infection, and none of the patients received long- term (> 3 months) antibiotic therapy. Reoperation for allograft revision, e xcision, or replacement was necessary in four patients (17%) who were avail able for examination, with no reoperative perioperative death. The 3-year p rimary and secondary allograft patency rates were 81% and 96%, respectively . Conclusion: Our experience with cryopreserved arterial allograft in the man agement of abdominal aortic infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complicat ions.