Cryopreserved Venous Allografts in Supra-inguinal Reconstructions: A Single Centre Experience

Abstract

WHAT THIS PAPER ADDS The current study introduces arterial reconstructions with cryopreserved femoral and vena caval vein allografts as a novel technique in the supra-inguinal setting with a low rate of re-infections and acceptable number of graft re-interventions on mid term analysis. Objective: This study introduces a novel technique for supra-inguinal arterial reconstructions with cryopreserved femoral vein and caval allografts with a low re-infection rate and an acceptable graft re-intervention rate on early mid term analysis. Methods: Patients treated from February 2012 to March 2018 with cryopreserved venous allograft reconstructions owing to infection in the supra-inguinal area were reviewed retrospectively. The primary end points were re-infection and the treatment related mortality rate. Secondary end points were 30 and 90 day and overall mortality and graft re-intervention rate. Results: Of the 23 patients treated with cryopreserved venous allografts for infection in aorto-iliac area, 21 (91%) patients underwent reconstruction with cryopreserved femoral veins and two (9%) with vena cava. Indications for treatment were aortic graft infections (n ¼ 12 [52%]), mycotic aneurysms (n ¼ 5 [22%]), femorofemoral prosthetic infections (n ¼ 3 [13%]), anastomotic pseudo-aneurysms (n ¼ 2 [9%]), and aortic thrombosis with intestinal spillage (n ¼ 1 [4%]). In hospital and 90 day mortality were 9% (n ¼ 2); overall treatment related mortality during the median follow up of 15 months was 13% (n ¼ 3). During the follow up, two allografts were re-operated on owing to anastomotic dilatation and one because of re-infection, resulting in a reintervention rate of 13% (n ¼ 3). None of the grafts was lost and there were no amputations. At the end of follow up 17 patients (74%) were alive. KaplaneMeier estimation for survival was 76% (95% confidence interval [CI] 57%e95%) at one year and 70% (95% CI 49%e91%) at two years. Conclusion: Cryopreserved venous allografts appear to be an infection resistant and reasonably safe reconstruction material in the aorto-iliac axis based upon the early mid term analysis from a single centre experience. Further research is needed to compare their performance with other biological reconstruction material.

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

“…25,26 Other possibilities involve the use of cryopreserved arterial and venous allografts, where especially the latter seems like a viable option, particularly in cases where the deep veins are unsuitable. 27 However, cryopreserved grafts are not readily accessible for most vascular centres and dedicated cryopreservation programmes are currently only available in two Swedish university hospitals.…”

Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus

“…In a study of 23 supra-inguinal arterial reconstructions using cryopreserved venous allografts -5 of which were mycotic AAAsgraft reinfection occurred in only one patient and two required reintervention for anastomotic dilatation. 24 This is a similarly J o u r n a l P r e -p r o o f low rate of reinfection as found in the largest study of cryopreserved arterial allografts for aortic reconstruction, which reported reinfection in 8 of 220 (4%) of cases. 25 The use of cryopreserved vein in this setting remains uncommon; among 56 mycotic AAAs in a multicentre study of all cases across six countries from 2006-2016, only two procedures used cryopreserved venous allografts.…”

In Oncovascular Surgery Well Planned is Half Done: A Field That Still Requires Major Open Vascular Surgery

“…1,3 Furthermore, we have our own homograft bank at Helsinki University Hospital, where we cryopreserve mostly femoral veins obtained from cadavers to be used in oncovascular procedures to replace resected larger vessels. 4 While endovascular surgery has taken over the field of aortic surgery for occlusive disease and aneurysms, oncovascular surgery still requires true open surgery. As typical aortic procedures have decreased dramatically as a result of the endovascular "tsunami", teaching aortic surgery to trainees has become more difficult.…”