Use of Cryopreserved Aortoiliac Allograft (CAA) for Aortic Reconstruction in the United States

Abstract

Aortic infections, even with treatment, have a high mortality and risk of recurrent infection and limb loss. CAA has been proposed for in-line reconstruction to improve outcomes in this high-risk population. A multi-center study using a standardized database was performed at 14 of the highest volume institutions who used CAA for aortic infection. Two hundred and twenty patients (mean age = 65; M:F = 1.6/1) were treated since 2000 with 283 CAAs for prosthetic graft infection (59%), primary aortic infection (17%), enteric fistula/erosion (16%), mycotic aneurysm (4%), and other (4%). Intra-op cultures indicated infection in 66%, most frequently polymicrobial. Distal anastomosis was to the femoral artery, iliac, then distal aorta. 30-day mortality was 9% and procedure related major complications occurred in 24%, including persistent sepsis (n = 17), graft thrombosis (n = 9), graft/stump rupture (n = 8), recurrent CAA/aortic infection (n = 8), pseudoaneurysm (n = 6), recurrence of AE fistula (n = 4), and compartment syndrome (n = 1). Hospital LOS was 24 days. Ten (5%) required allograft explant; 2 developed CAA aneurysm requiring resection at 23 and 40 mo. Primary graft patency and freedom from limb loss were 93% and 97%, respectively, at 5 yr. Patient survival was 75% at 1 yr and 51% at 5 yr. This largest study indicates that CAA allows in-line reconstruction of aortic infection with lower early and long-term morbidity and mortality than other previously reported treatment options. Repair with CAA is associated with low rates of aneurysm formation, recurrent infection, and limb loss.