Management of primary mycotic aneurysms and prosthetic graft infections: an 8‐year experience with in‐situ cryopreserved allograft reconstruction

Abstract

Background Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra‐anatomical bypass. Long‐term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in‐situ arterial reconstruction using cryopreserved allograft as a conduit. Methods The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). Results There were three peri‐operative mortalities (23%) with all three mortalities related to graft re‐infection and post‐implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re‐infection or aneurysmal degeneration. Conclusion Patients that survived the peri‐operative period demonstrated acceptable medium‐term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide‐spread use in our state remains inadequate supply of banked cryopreserved tissue.

Improved Repopulation Efficacy of Decellularized Small Diameter Vascular Grafts Utilizing the Cord Blood Platelet Lysate

“…Consequently, the host inflammatory response attributed by neutrophils and M1 macrophages is initiated, leading to platelet activation and aggregation [ 59 ]. Additionally, the cryopreserved allografts are characterized by increased bacterial infections [ 60 ]. In this way, the development of well-defined SDVGs requires further evaluation.…”

Homograftok használata érsebészeti fertőzésekben

“…A korai halálozási arány (<30 nap) 2,8% és 42,8% közé tehető. 5 tanulmány 10% alatti korai halálozásról számol be [13,[15][16][17], 3 vizsgálat 10% és 25% közötti arányt ÖSSZEFOGLALÓ KÖZLEMÉNY említ [18,19], és 1 közlemény írja le a halálozási arányt 40% felettinek [20]. Az utóbb említett publikáció korai halálozási eredménye extrém magas, az irodalmi adatokban azonban találunk ezzel összhangban lévő, hasonlóan magas halálozási adatokról beszámoló cikket.…”

“…Az összefoglaló közleményünkben elemzett cikkek alapján a reinfekciós arány minden esetben 10% alattinak bizonyult az aortaszakaszon előforduló fertőzések tekintetében. Több közlemény is arról számol be, hogy egyik vizsgált esetben sem fordult elő reinfekció [17][18][19][20]. Öszszesen 1 publikáció említ magasabb reinfekciós arányt, mely 8,5% volt [6].…”