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DOI: 10.1055/s-0029-1246680
Cryopreserved arterial homografts in vascular infections: the Hannover experience
Purpose: Short- as well long-term results in patients with abdominal aortic/prosthetic-graft infection managed by means of in situ aortic reconstruction with cryopreserved arterial homograft (CAH) were reviewed.
Material and methods: From 01/2000 to 12/2008, 110 patients underwent CAH implantation against vascular infections. In 57/110 (52%) patients, an in situ revascularization of the abdominal aorta with Y-prosthesis constructed from CAH was performed. In-hospital postoperative course in terms of infections markers [leucocytes, C-reactive protein (CRP) and peak body temperature (PBT)], platelets count and microbiological results as well as long-term mortality- and freedom from reoperation (FFR) rates due to a recurrence of infection or a graft-related complication were reported.
Results: 30-day mortality was 9%. Causes of death was sepsis-related multiple organ failure (n=3) and heart failure intraoperatively (n=2). The peak value of leucocytes (13.7±4.4×103/l) and CRP (200±75mg/l) was developed on POD3. Platelets reached the lowest value on POD2 (178±67×109/l). All parameters returned in preoperative values. PBT was 37.7±0.6°C. The most frequent microorganism intraoperatively was Staphylococcus aureus (25%). Absence of the pathogen agent(s) in the postoperative specimens (wound, blood culture, drainage) was obtained in 82% of patients. Median follow-up was 36 (4–118) months. 3-year survival- and FFR rates amounted to 81% and 89% respectively. Noone of patients died due to a graft-related complication in the long run. 5/57 (9%) patients were reoperated.
Conclusions: These results show encouraging outcomes after implantation of CAH against vascular infections in abdominal aorta. Comparison between CAH and other established types of treatment (silver prosthesis, autogenous femoral vein) remains mandatory.