Cryopreserved aortic homografts for mycotic aneurysms and infected arterial grafts

Abstract

The treatment of mycotic aneurysms and infected arterial grafts is a special challenge to the vascular surgeon. As late as 1967, Benett considered infected aneurysms of the abdominal aorta to be invariably fatal (4). Today, almost 30 years later, the management of mycotic aneurysms and infected arterial grafts remains a difficult problem. Complete removal of all infected prosthetic material and reconstruction with extraanatomic bypass is widely recommended as the only possible solution, although prosthetic in situ replacement of mycotic aneurysms and infected grafts, with local and systemic antibiotics, has also been tried. A large variety of treatment modalities has been developed and overall results improved in recent years. Nevertheless, mortality rates of up to 50% and amputation rates of up to 60% are reported (5, 33, 34, 36, 48, 57). Above all, the surgery for mycotic aortic aneurysms and aortic graft infections remains the most demanding technical challenge, due to operative difficulties encountered in heavily scarred, infected regions.