Cryopreserved venous allograft is an acceptable conduit in patients with current or prior angioaccess graft infection (original) (raw)
Related papers
Cryopreserved arterial allograft reconstruction for peripheral graft infection
Journal of Vascular Surgery, 2005
Objective: This prospective, observational study evaluated the safety and efficacy of cryopreserved arterial allograft reconstruction in the management of major peripheral arterial graft infections. Methods: From April 1996 to May 2003, data from patients with major peripheral arterial graft infection who underwent graft excision and cryopreserved arterial allograft reconstruction were prospectively collected. Arterial allografts were harvested from multiple organ donors and cryopreserved at ؊80°C. The patients were observed for survival, limb salvage, persistence or recurrence of infection, and allograft patency. The results were calculated with the Kaplan-Meier method. Results: During the 7-year study period, 17 patients (14 men, 3 women; mean age, 68 years) with major peripheral graft infection underwent graft excision and cryopreserved arterial allograft reconstruction. Eight patients (47%) had systemic sepsis, 5 (29%) had acute ischemia at the time of the allograft reconstruction, and 9 (53%) had experienced anastomotic rupture. Allograft reconstruction was performed as an emergency procedure in 7 patients (41%). There were no perioperative deaths or early amputations. Two patients had allograft ruptures in the groin during the early postoperative period. The mean follow-up period was 34 months (range, 8 to 80 months). There was no persistent or recurrent infection, and none of the patients received long-term (>3 months) antibiotic therapy. Reoperation for allograft revision, excision, or replacement was performed in 2 patients. The 18-month primary and secondary allograft patency rates were 68% and 86%; the overall limb salvage rate was 82% at 2 years. Conclusion: Our experience with cryopreserved arterial allograft in the management of major peripheral bypass graft infection suggests that this technique seems to be a useful option for treating one of the most dreaded vascular complications. ( J Vasc Surg 2005;41:30-7.) From the Service de Chirurgie Vasculaire et Thoracique, a and Service d'anesthésie-réanimation, b Hôpital Beaujon, Assistance Publique Hopitaux de Paris (AP-HP). Competition of interest: none.
Journal of Vascular Surgery, 2009
Objectives: Vascular reconstruction in the setting of primary arterial or prosthetic graft infection is associated with significant morbidity and mortality. Cryopreserved human allografts (CHA) may serve as acceptable alternatives when autogenous or extra-anatomic/in situ prosthetic reconstructions are not possible. Methods: Between February 1999 and June 2008, 57 CHAs were placed in 52 patients (average age, 65 years) for abdominal aortic (n ؍ 18) or iliofemoral/femoral-popliteal arterial or prosthetic infections (n ؍ 39). Indications for arterial reconstruction included infected implanted prosthetic material (n ؍ 39), mycotic pseudoaneurysms (n ؍ 14), or intra-abdominal bacterial contamination or wound infection (n ؍ 4). Wide local debridement and culture was followed by allograft interposition, bypass, or extra-anatomic reconstruction. Over a similar time period, 53 non-CHA extraanatomical prosthetic or in situ autogenous tissue reconstructions were performed in 53 patients (average age, 65 years) for abdominal aortic (n ؍ 18) or iliofemoral and femoral-popliteal (n ؍ 35) prosthetic graft infections. Indications for arterial replacement in all cases included infected implanted prosthetic material.
Late Fate of Cryopreserved Arterial Allografts
European Journal of Vascular and Endovascular Surgery, 2016
WHAT THIS PAPER ADDS This clinical series of 103 consecutive vascular reconstructions with cryopreserved arterial allografts in infected vascular fields underscores the necessity for close post-operative surveillance because of a substantial rate of early and late graft-related complications. Some technical tricks are described to minimize the risk of allograftrelated complications. Objective: Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. Material and methods: A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). Results: The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. Conclusion: This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.
Infection of Hemodialysis Arteriovenous Grafts
The Journal of Vascular Access, 2010
Purpose Prosthetic arteriovenous grafts (AVG) are bedeviled by significant infectious complications. This study was to determine the infectious complications of prosthetic AVG and review the relevant literature. Methods All prosthetic AVG inserted between January 2000 to December 2007 were studied. Data on age, sex, date of graft insertion, indication for aVG, site of graft insertion, date of graft related infection, treatment and outcome for graft and patients were analyzed. Results There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates′ x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates′ x2=1.123; df=1; ...
Journal of Vascular Surgery, 2002
Purpose: In situ repair with cryopreserved vascular allografts improves the results in the surgical treatment of aortic infection. This study evaluated the technical pitfalls with the use of allografts that influence early and midterm mortality. Methods: Between 1990 and 1999, 49 patients, 21 (43%) with a mycotic aneurysm and 28 (57%) with a prosthetic graft infection of the thoracic and abdominal aorta including pelvic and groin vessels, underwent in situ repair with cryopreserved arterial allografts. Seventeen patients (35%) had aortobronchial, aortoesophageal, or aortoenteric fistulas. Results: Allograft-related technical problems occurred in eight patients (16%) in this series, and they included: intraoperative rupture caused by allograft friability; allograftenteric fistula from ligated allograft side branches rupturing 8, 18, and 48 months after implantation; anastomotic failure caused by inappropriate mechanical stress; anastomotic stricture after partial replacement of infected prosthetic grafts; allograft failure caused by inappropriate wound drainage; and recurrence of infection after inappropriate duration of antifungal treatment. Seven of the eight technical problems (87%) occurred in the first 10 patients (80%) in this series. There was one technical failure in the remaining 39 patients (2.6%; P = .0002) because of various technical adaptations, such as critical selection of allografts, use of allograft strips supporting large anastomoses, sealing with antibiotic-impregnated fibrin glue, and change in technique of allograft side-branch ligature. The 30-day mortality rate was 6% for the whole series; however, it was 2.6% for last 39 patients, with no recurrence of infection or allograft-related late death. Conclusions: In situ repair with cryopreserved arterial allografts achieves excellent early and late results in the treatment of aortic infection. However, distinct allograft-related technical problems had to be overcome to improve the outcome of patients with major vascular infections. (J Vasc Surg 2002;35:80-6.)