Cryopreserved arterial allografts used for the treatment of infected vascular grafts

In this study, 18 patients (17 men and 1 woman; mean age 61 years) with a previously infected vascular graft underwent vascular reconstruction with cryopreserved arterial allografts. Treatment consisted of first total (n = 11) or partial removal (n = 7) of infected prosthetic grafts. Revascularizations were aortoaortic (n = 2), aortobifemoral (n = 8), aortounifemoral (n = 3), femorofemoral (n = 2), iliofemoral (n = 1), or femoropopliteal (n = 2) bypasses. Four patients died postoperatively (22%)-one of septic necrosis of the allograft, one of septic rupture of the aortic anastomosis of a previous bypass, one of multiorgan failure, and one of mesenteric infarction. One allograft occluded within 30 days (5.5%), leading to an above-knee amputation, in the remaining patients, routine arteriography or duplex scan showed patent allografts. For the 14 survivors, the mean follow-up period was 20 months (range: 1-45 months). Two patients died-one of septicemia not related to the allograft, and one of multiple organ failure. Among the 12 survivors, 3 patients with non-ABO-compatible allografts developed different types of long-term alterations. One patient had a hemorrhage due to femoral allograft rupture at 45 days, and two patients had aortic allografts dilatation with mural thrombus, necessitating a prosthetic replacement in one patient. Cryopreserved allografts used for the treatment of infected vascular graft are useful in selected cases, although they are not totally resistant to infection. Patients should be followed closely to detect significant long-term alterations of the allografts.