Cryopreserved Cadaveric Arterial Allograft for Arterial Reconstruction in Patients with Prosthetic Infection

Abstract

Use of cryopreserved arterial allografts provides acceptable results but is tempered by suboptimal 5 year outcomes with high re-intervention rates.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…Allograft related re-intervention rates were found in up to 55% of patients after five years (Table 8). 147 However, a better outcome with no dilatation or aneurysm during a mean follow up of five years was observed in another series of 71 patients. 154 Survival rates varied between 40% and 54% after five years.…”

Editor's Choice – Cryopreserved Allografts for Arterial Reconstruction after Aorto-Iliac Infection: A Systematic Review and Meta-Analysis

“…However, even this operation is not ideal; it is lengthy, with significant venous morbidity, including post-operative fasciotomy and higher late rupture rate and secondary interventions. 1,36 To anticipate the disadvantages of synthetic and venous grafts, allografts have been used for in situ arterial reconstruction. Fresh allografts have been mainly abandoned because of high dilatation rates over the time.…”

“…1 Among their main advantages is that they are less prone to infection, require only a short surgical duration, and are associated with low morbidity and mortality. 36 Furthermore, cryopreserved allografts are processed so that they do not require blood group matching, they can be pre-selected to match the size of the recipient's aorta and branches and they generally include visceral, renal, and hypogastric side branches, which can be used for bypass to renal and visceral vessels. 30 Limitations of the technique include that a predefined, dedicated, and very detailed protocol of tissue harvesting is mandatory.…”

“…Moreover, allografts usually require several parts to be connected, anastomoses should be tension free, side branches should be ligated securely when not needed, and sufficient tissue debridement in the area before implantation should be performed meticulously to avoid reinfection. 36 Lastly, although allografts are soaked in antibiotics during their preparation, patients should receive longterm antibiotic therapy after implantation. 1 However, it should be highlighted that antibiotic soaking of allografts is a prophylactic measure, which is not part of the long-term antibiotic treatment of the initial infection, which duration depends on many other factors, such as the type of the initial infection and the results of the per-operative microbiological samples.…”

“…The study period of all included studies ranged from 1966 38 to 2017. 1,31,36 Interestingly, the first reported study included a high volume of 116 patients treated with cryopreserved allografts. 38 Males comprised 74.2% of the entire patient cohort with a mean age >60 years.…”