Radical Operation of Infected Aortofemoral Prosthesis using Fresh Arterial Allograft: Our Mid-term Experience


Authors: P. Šebesta ;  P. Štádler ;  P. Šedivý ;  P. Zdráhal ;  K. El Samman ;  V. Jindrák *;  M. Syrůček **
Authors‘ workplace: Oddělení cévní chirurgie, Nemocnice Na Homolce, primář doc. MUDr. P. Štádler, Ph. D. ;  Oddělení mikrobiologie, Nemocnice Na Homolce, primář MUDr. V. Jindrák *;  Oddělení patologie, Nemocnice Na Homolce, primář MUDr. M. Syrůček **
Published in: Rozhl. Chir., 2011, roč. 90, č. 1, s. 4-13.
Category: Monothematic special - Original

Overview

Introduction:
The mid-term experience with the use of the fresh arterial allografts in the treatment of aortic or aortofemoral prosthetic infection is presented.

Material and methods:
Between 2001–2010 24 patients (23 with the infected graft in aortic or aortofemoral position and one with a mycotic aneurysm of the aortic bifurcation) were operated with the use of the fresh arterial allograft. Male/female ratio was 15/9, average age 65.8 (36–81) years. The gastrointestinal comorbidities dominated this cohort. The total of 70 previous vascular operations (1–9; m. 2.9/patient) were performed with the median of 5.8 years between the first and the last procedure. Seven patients had sepsis (29.2%), aortoeneteric fistula occurred in three. Various technical modifications of the aortobifemoral (13), aortounifemoral (8) bypass, aortic and aortoiliac replacement (3) were performed including the sequential distal reconstructions. The arterial allograft was used within 8–48 hours following harvest (the median cold ischemic time of 20 hours) and all patients were given cyclosporine A perioperatively.

Results:
In-hospital mortality was 20.8% (5/24), twice caused by postoperative hemorrhage from either the aortic anastomosis or the graft necrosis. The remaining deaths were not related to the allograft itself. Two limbs, preoperatively ischemic, were amputated (8.3%). The median follow-up is 4.6 years (3 m.–8 yrs.). The three-years survival was 68.4% and the known causes of death had no relation to the allograft. The late occlusion of the graft limb occurred twice, stenoses within its course twice and three femoral anastomotic stenoses were disclosed. All were treated either surgically or by PTA/stent and the redo procedures’ rate has thus reached 20.5% in the mid-term follow-up interval. One graft has shown a slight diffuse dilatation since requiring but follow-up.

Conclusions:
Under the conditions of the ABO compatibility tolerance and ongoing postimplantation immunosuppression the shortly ischemic arterial graft helds its anatomic structure and function and within the hostile setting of the previous infection represents a valuable alternative of the surgical treatment of the vascular prosthetic infection in the aortofemoral position or of the mycotic aneurysm.

Key words:
vascular prosthetic infection – arterial allograft – immunosuppression


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Surgery Orthopaedics Trauma surgery

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