Cryopreserved Allograft in the Management of Native and Prosthetic Aortic Infections

Abstract

The management of patients with aortic native and prosthetic infections is associated with significant morbidity and mortality. We describe a single-center experience with the use of cryopreserved allografts for the treatment of aortic infections, and compare outcomes with rifampin-soaked grafts and extra-anatomic bypass. We retrospectively reviewed all patients who underwent an operative intervention for aortic infection at our tertiary care center from August 2007 to August 2017. Demographic data, preoperative work-up, procedural details, and outcomes were collected for each treatment modality. Thirty-two patients had aortic revascularization for aortic infection. Seventeen patients had cryopreserved allografts, 10 had rifampin-soaked grafts, and 5 had extra-anatomic bypass. Sixteen patients (50%) had native aortic infection and 16 patients (50%) had prosthetic aortic infection. Eighteen had involvement of the infrarenal abdominal aorta, 12 of the paravisceral aorta, and 2 of the descending thoracic aorta. Early mortality was 5.9% (1/17) for the cryopreserved group, 10% (1/10) for the rifampin-soaked group, and 40% (2/5) for the extra-anatomic bypass group. Early graft-related complications occurred in 1 patient (cryopreserved group). Mean follow-up was 34.8months. Late death occurred in 4 patients with cryopreserved allografts, 2 with rifampin-soaked grafts and none with extra-anatomic bypass. Late graft-related complications occurred in 4 patients (cryopreserved group). Only 1 patient had recurrence of aortic infection (cryopreserved group) and 2 patients had limb loss (1 from the cryopreserved group and 1 from the rifampin-soaked group). At 1month, 6months, 1year, and 3years, estimated survival for patients with cryopreserved allografts was 94%, 82%, 75%, and 64%, respectively. The management of aortic infections is challenging. In patients who do not need immediate intervention, in situ aortic reconstruction with cryopreserved allografts is a viable treatment modality with relatively low morbidity and mortality.