Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients

Kieffer, Édouard; Gomes, Dominique; Chiche, Laurent; Fléron, Marie-Hélène; Koskas, Fabien; Bahnini, Amine

doi:10.1016/j.jvs.2003.12.040

Cited by 270 publications

(213 citation statements)

References 42 publications

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“…Also, availability and costs limit more widespread use. Furthermore, 5 patients in the present study were treated with fresh allografts, which are known to have even higher risk for complications 26. Despite the lack of signs of degeneration in the current cohort, we call for caution and suggest using autologous femoral veins or cryopreserved allografts if possible.…”

Section: Discussionmentioning

confidence: 81%

See 1 more Smart Citation

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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BackgroundThe treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.Methods and ResultsAll patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30‐ and 90‐day survival, treatment‐related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty‐six patients (46 males) with median age of 69 years (range 35–85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In‐situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube‐grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow‐up of 26 months (range 3 weeks–172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty‐day survival was 95% (n=53) and 90‐day survival was 91% (n=51). Treatment‐related mortality was 9% (n=5). Kaplan–Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%–94%) and at 5 years was 71% (52%–89%).ConclusionsMycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

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Section: Discussionmentioning

confidence: 81%

“…Cryopreservation has improved the permanence of allografts, but degeneration, possible aneurysmatic dilatation, and subsequent rupture remain challenging 22, 26, 27, 28. Also, availability and costs limit more widespread use.…”

Section: Discussionmentioning

confidence: 99%

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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“…Studies have demonstrated that cryopreserved allograft replacement is an effective and durable alternative for the treatment of aortic prosthetic graft infection, with improved outcomes in comparison with the traditional treatment of graft excision and extra-anatomic bypass grafting. But concerns about their availability, preservation, and risk of later deterioration avoids the widespread use of this alternative [10][11][12][13][14]. …”

Section: Discussionmentioning

confidence: 99%

In situ reconstruction with bovine pericardial tubular graft for aortic graft infection

Dulbecco¹,

Camporrotondo²,

Blanco³

et al. 2010

Rev Bras Cir Cardiovasc

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“…A major drawback of cryopreserved allografts is the risk of degeneration leading to calcifi cation, dilatation, or even rupture. Kieffer (44) referred that the use of cryopreserved allograft is of particular benefi t in patients with AEF reducing the one-year mortality rate from 34 % with the use of conventional grafts to 9 %. The major problem of the use of allografts is their shortage especially in hospitals without allograft banks, as well as in hospitals not involved in transplantation program.…”

Section: Treatment Optionsmentioning

confidence: 99%

Management of aortic graft infections – the present strategy and future perspectives

Treska¹,

Certík²,

Moláček³

2016

BLL

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Aortic graft infections (AGI) are serious complications of open and endovascular types of surgery with an incidence rate of 0.6-3 %. AGI are associated with 30-60 % perioperative mortality and 40-60 % morbidity rate with limb amputation rates between 10 % and 40 %. The economic cost of AGI is substantial. At the time of aortic reconstruction, almost 90 % of patients have one or more predisposing factors for AGI. The diagnosis is based on clinical symptomatology, laboratory markers, microbial cultures, and imaging modalities. The general principle of surgical treatment lies in the removal of infected graft, debridement of infected periprosthetic tissues, and vascular reconstruction by in situ or extra-anatomic bypass with long-term antibiotic therapy. The conservative treatment is used only for selected patients with endograft infection. This review summarizes the current knowledge about the incidence, predisposing factors, etiology, diagnosis, treatment options, and prevention of aortic vascular graft and endograft infections. With the growing number of endovascular procedures we can expect more cases of infected aortic endografts in patients with severe comorbidities in the near future, where the recent radical surgical approach (graft excision, debridement, and new revascularization) cannot be used. Therefore the less invasive, sophisticated and individualized treatment strategies will have to be used in search of the best therapeutic approach to each specifi c patient (Fig. 4, Ref. 82). Text in PDF www.elis.sk.

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Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients

Cited by 270 publications

References 42 publications

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

In situ reconstruction with bovine pericardial tubular graft for aortic graft infection

Management of aortic graft infections – the present strategy and future perspectives

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