Outcomes Of Cryopreserved Allografts For Aortic Infections
Mohammad A. Khasawneh, MD, Manju Kalra, MBBS, Gustavo Oderich, MD, Jill Colglazier, MD, Randall DeMartino, MD, Bernardo Mendes, MD, Thomas C. Bower, MD.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: To define outcomes of cryopreserved aortic allograft (CAA) used to treat primary aortic or aortic prosthetic graft/ endograft infection.
METHODS: Data from consecutive patients undergoing aortic reconstructions with CAA to treat infected aortic aneurysms, grafts or endografts from 2003 through 2018 were retrospectively analyzed. End-points include early (30-day) mortality and late patient survival, reinfection, reintervention and graft-related hemorrhage.
RESULTS:Forty six patients (76 % males with mean age 67±10 years) were included in the study; 36 (78%) had infected endografts (21) or open surgical grafts (15) and 10 (22%) had infected aneurysms. The segments involved by infections included the infrarenal (34), paravisceral (8), thoracic (3) and thoracoabdominal aorta (1). 15 (33%) patients had aortoenteric fistula and one had aortobronchial firstula; 23 (51%) patients had periaortic abscesses formation and 8 (18%) had supragraft anastomotic pseudoaneurysms. Preoperative cultures were positive in 32/38 (82%) patients. A remote infectious source was identified in 25 patients. Time from onset of symptoms to diagnosis was 175±367 days. Symptoms of systemic infection were present in 38 patients; 5 patients presented with rupture and 4 patients were asymptomatic. Among patients with infected grafts/endografts, explantation was complete in 33 and partial in 3. All patients had in situ reconstruction using 37 bifurcated (32 iliac and 5 femoral) and nine straight grafts (27%). Circumferential omental wrap was performed in 39 patients. Thirty day mortality was 2% and major morbidity occurred in 26% patients with median length of stay was 13 (9-21) days (mean 20 days). Over a median follow up of 14 (7-32) months (mean 24), none of the patients had aortic-related death, reinfection, limb loss or spontaneous aortic/allograft rupture. Reinterventions were needed in three patients to treat anastomotic stenoses. CONCLUSIONS: Cryopreserved aorto-iliac allograft is now our conduit of choice for infected endografts, and primary aortic and secondary aortic infection from virulent organisms. Operative mortality and reinfection has been low but complication rates are high. In our experience, there were no late aneurysm or rupture of the allograft during the follow up period.
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