In Situ Reconstruction With Custom-Made Bovine Pericardial Grafts for Aortic Graft Infections and Infected Aortic Aneurysms

Abstract

Graft infections are rare, but serious, complications of vascular surgeries, and the most appropriate material for reconstruction has continued to be debated. The aim of the present study was to evaluate the results of in situ aortic reconstruction with custom-made bovine pericardial grafts. A retrospective analysis was performed for all patients who had undergone in situ aortic reconstruction with custom-made bovine pericardial tube grafts from January 2009 to February 2020 at our academic tertiary center. Complete excision of the infected graft or aortic segment, extensive debridement, and in situ reconstruction with bovine pericardial grafts were applied in all patients. Perioperative and mid-term outcomes, including mortality and freedom of reinfection, were analyzed. A bovine pericardial graft was used in 31 patients (71% male), with a median age of 69 years (range, 46-88 years) to reconstruct the descending thoracic aorta (n = 3), thoracoabdominal aorta (n = 1), and abdominal aorta (n = 27). Of the 31 patients, 16 (51%) were treated for infection of the native aorta and 15 (49%) for prosthetic graft infection. The 30-day mortality was 9.7%. Three cases of reinfection after bovine reconstruction were observed in our cohort and had developed because of recurrent aortoduodenal fistulas. Limb graft occlusions were detected in two cases during follow-up. The outcomes associated with custom-made bovine pericardial grafts compare favorably with those of more traditional treatment modalities. It can be used as an alternative technique when replacing aortoiliac segment in patients with aortic graft infections and infected aortic aneurysms, if other options are not recommended or not possible. It is associated with good patency, a low reinfection rate, and acceptably low early mortality rate. Its ease of use and the rapidity of prosthesis construction have made it the material of choice at our institution.