Self-Made Bovine Pericardial Tube Grafts for the Treatment of Abdominal Aortic Infections

Abstract

Aortic infections are an uncommon but life-threatening disease. The material of choice for aortic reconstruction is still a matter of debate. The aim of this study is to examine the short and mid-term outcomes in the treatment of abdominal aortic infections using self-made bovine pericardium tube grafts. This retrospective, single-center study collected all patients who underwent in situ abdominal aortic reconstruction using self-made bovine pericardial tube grafts between February 2020 and December 2021 in a tertiary care center. Patient comorbidities, symptoms, radiological, bacteriological and peri-operative findings, as well as postoperative outcomes were analyzed. Bovine pericardial aortic tube grafts were used in 11 patients (10 male, median age 68.7 years). Two patients presented a native aortic infection and nine had graft infections (four bypass grafts, four endografts and a plurioperated patient who had undergone both endovascular and open procedures). There were two emergent surgeries due to infectious aneurysm ruptures. All patients were symptomatic and the most frequent clinical finding was lumbar or abdominal pain (36%), followed by wound infection (27%) and fever (18%). Seven bifurcated and four straight pericardial tube grafts were needed. Purulent drainage was obtained around the previous graft or in the aneurysmal sac in 7 cases; intraoperative cultures were positive in 6 cases (Gram + bacteria). Two patients died in the immediate postoperative period (perioperative mortality 18%; urgent procedures 50%; scheduled procedures 11%). One patient had a major complication due to bilateral SARS-CoV2 pneumonia. There was one single reintervention to control hemostasis due to bleeding non-graft-related. The median follow-up was 14.1 months (3-24 months). Our preliminary experience in the treatment of abdominal aortic infections by in situ reconstrucción with self-made bovine pericardial tube grafts shows promising results. These should be confirmed in the long term.