Cryopreserved Allograft in the Management of Native and Prosthetic Aortic Infections

Masabni, Khalil; Weaver, Mitchell R.; Kandagatla, Pridvi; Shepard, Alexander D.; Huang, Jordan; Adas, Ziad Al; Liang, Liang; Balraj, Praveen; Nypaver, Timothy J.; Kabbani, Loay

doi:10.1016/j.avsg.2018.09.010

Cited by 13 publications

(7 citation statements)

References 37 publications

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“…In this localization, cryopreserved homografts represent traditionally the only non-prosthetic alternative. However, the availability (4,6), as well as the risk for re-infection, degeneration and bleeding (4,21,24) as well as the still lacking long-term results (1) remain a relevant limitation of aortic reconstructions with this type of graft material. Therefore, readily available nonprosthetic materials are particularly attractive for treating AI.…”

Section: Discussionmentioning

confidence: 99%

Xenogeneic materials for the surgical treatment of aortic infections

Keschenau¹,

Gombert²,

Barbati³

et al. 2021

J Thorac Dis

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Background: The surgical treatment of aortic infections (AIs) is challenging. In situ aortic reconstructions represent nowadays the favored therapy for fit patients and xenogeneic materials are used increasingly. The aim of this study was to present our experience with xenogeneic reconstructions for AI using self-made bovine pericardium tubes and/or the biosynthetic Omniflow ® II graft. Methods: This retrospective single-center study included all patients undergoing xenogeneic aortic and aortoiliac reconstructions from December 2015 to June 2020. Patient comorbidities, symptoms, procedural characteristics, types of pathogens and postoperative outcomes were analyzed. Results: Twenty-eight patients [23 male (82%), median age 68 (range, 28-84) years] were included. Ten patients (36%) had native AIs and 18 (64%) had graft infections, including 3 (11%) aortoesophageal and 2 (7%) aortoduodenal fistulas (ADF). Twenty-four patients (86%) were symptomatic, the most common symptoms being contained aortic rupture (n=8) and sepsis (n=4). The surgical procedures were infra-and juxtarenal aortic repairs (n=11, 39% and n=7, 25%), thoracoabdominal aortic repairs (type IV: n=1, 4%; type V: n=3, 11%), descending thoracic aortic repairs (n=4, 14%) and 2 reconstructions (7%) involving the ascending aorta/aortic arch. Most were urgent (n=10, 43%) or emergent operations (n=11, 35%). Identification of pathogen(s), mostly Gram-positive bacteria, was possible in 25 patients (89%). Twelve patients (43%) had polymicrobial infections and 6 (21%) infections with multi-resistant bacteria. In-hospital mortality was 32% (n=9) due to acute cardiac failure (1/9), endocarditis (1/9), bleeding (3/9) and sepsis (4/9). The most frequent complications were transient need for dialysis (n=12, 43%) and persisting sepsis (n=11, 39%). Two early occlusions of Omniflow ® II grafts were observed (7%). Median follow-up (FU), during which 2 patients died of non-aortic causes, was 14 months (95% CI: 9-19 months). Freedom from reoperation was 100%, there was no evidence for reinfection during FU. Conclusions: Xenogeneic orthotopic reconstructions for AI can be performed at all aortic levels.Combining bovine pericardium and the Omniflow ® II graft can be useful for reconstructing the branched aortic segments and both materials show appropriate early to midterm outcomes. Nonetheless, AIs are serious conditions associated with relevant morbidity/mortality rates, even in a specialized center.

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Section: Discussionmentioning

confidence: 99%

Xenogeneic materials for the surgical treatment of aortic infections

Keschenau¹,

Gombert²,

Barbati³

et al. 2021

J Thorac Dis

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“…Furthermore, suture lines and anastomotic stumps (after EAB) are protected from leakage, rupture, or blowout [57,61,62] . Several conduits are available for revascularization with differing advantages one each other: cryopreserved allografts represent the most biological solution with a low risk for re-infection (0%-7%) [58,[63][64][65][66] . Rifampicinbonded and silver-coated grafts have the lowest limb amputation rate of around 3% and are an excellent solution for emergency procedures, mainly in the abdominal and pelvic location [67] .…”

Section: Oral Treatment Ciprofloxacinmentioning

confidence: 99%

“…Rifampicinbonded and silver-coated grafts have the lowest limb amputation rate of around 3% and are an excellent solution for emergency procedures, mainly in the abdominal and pelvic location [67] . Major drawbacks are the limited availability and graft-related complications from degeneration of cryopreserved allografts [58,64] and the relatively high rate of re-infection (> 10%) in rifampicin-bonded and silver-coated grafts.…”

Section: Oral Treatment Ciprofloxacinmentioning

confidence: 99%

“…In general, the literature regarding the management of thoracic VGIs is scanty, and most of the available documents are surgical case series or retrospective studies with a limited number of patients [21,64,77,79] . Currently, and as a natural consequence of broader use of TEVAR compared to open repair, infected endografts are more commonly observed and reported [80] .…”

Section: Special Situations: Fistula and Partial Graft Resectionmentioning

confidence: 99%

“…The use of cryopreserved allografts has been studied by several authors [64,88,90,91] and has been accepted as a viable solution in infected scenarios due to their resistance to infection. At a median of 2.4 years after implantation, Preventza et al [90] achieved 100% freedom from reinfection, and Lytle et al [92] documented only one patient with an infected homograft.…”

Section: Aortic Root Ascending Aorta and Aortic Archmentioning

confidence: 99%

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Vascular graft infections

Hemelrijck¹,

Sromicki²,

Husmann³

et al. 2022

Vessel Plus

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Vascular graft infections are rare complications after surgical and endovascular treatment of aortic diseases. This condition is characterized by complexity in diagnosis and medico-surgical management. Moreover, even if properly treated, morbidity and mortality rates are high. Although several advances have been made over the years and guidelines of treatment have been published, there is still debate on the optimal care for this disease. With local microbiological patterns and multiresistant strains conditioning antimicrobial treatment as well as several surgical debridement techniques in the armamentarium, it is difficult to offer recommendations that can be generalized for every single case. In this review, we aim at describing thoracic and abdominal vascular graft infections and providing current information on diagnosis, medical treatment, and surgical management.

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