Peripheral Arterial Reconstructions Using Cryopreserved Arterial Allografts in Infected Fields
Courtney L Furlough, Ashish K Jain, Karen J Ho, Heron E Rodriguez, Mark Eskandari
Northwestern University, Chicago, IL
INTRODUCTION: Cryopreserved human arterial allografts are a recognized acceptable alternative for vascular reconstruction when other traditional conduits are either unavailable or contraindicated. We reviewed our experience using cryopreserved arterial allografts for peripheral arterial reconstructions in contaminated and infected surgical fields.
METHODS: Single-center, retrospective review of 59 patients who underwent a peripheral vascular arterial reconstruction using a cryopreserved arterial allograft from January 2002-July 2017. Indications for repair included removal of infected prosthetic bypass (n=35), revascularizations in contaminated fields (n=7), primary arterial repair in setting of infection (n=11), infected vascular closure devices (n=6). Aortic-based repairs were excluded. Demographics, index procedural details, postoperative complications, and conduit patency were analyzed. Primary endpoints included graft patency and graft failure as measured by reinfection, hemorrhage, or degeneration. Mean follow-up for the study is 27.8 months (range 2-125 months).
RESULTS: A total of 59 peripheral vascular arterial reconstructions using cryopreserved arterial allografts were performed over the 15 year period. Among the 22 women and 37 men treated, the mean age was 61 years. The vascular beds involved included: iliofemoral (n=40), femoropopliteal or femoral-distal (n=11), axillosubclavian or brachial (n=2), mesenteric (n=3), and carotid (n=3). Adjunctive muscle flap coverage of the allograft conduit was performed in the majority of cases (63%, n=37). The 30-day mortality was 9.3%, however none of the deaths were conduit-related. The 30-day conduit-related complication rate was 18.5% and included: hematoma/hemorrhage from the graft requiring return to operating room (n=5), surgical wound dehiscence/infection (n=3), and graft reinfection (n=2). The late conduit-related complication rate was 14.8% and included: graft infection (n=3), major amputation (due to graft occlusion) (n=1), pseudoaneurysm degeneration requiring repair (n=2), graft hemorrhage (n=1), and symptomatic graft stenosis necessitating re-intervention (n=1).
CONCLUSIONS: Peripheral vascular reconstruction using a cryopreserved arterial allograft is a useful alternative conduit in infected/contaminated surgical fields when other autologous or prosthetic conduits are either unavailable or contraindicated. In the immediate postoperative period, these repairs demonstrate acceptable resistance to graft failure and reinfection particularly when used in conjunction with adjunctive rotational muscle flap coverage. Late conduit-related complications are infrequent, yet longer term analysis is required.
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