Cryopreserved arterial homografts for in situ reconstruction of mycotic aneurysms and prosthetic graft infection

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Abstract
The management of mycotic aneurysms and prosthetic graft infection ofmajor thoracic and abdominal vessels and infected extra-anatomic bypassremains a problem in vascular surgery. Cryopreserved arterial homografts,being resistant to infection, offer hope for in situ vascularreconstruction in the presence of an infection. We analyzed clinical,microbiological, preoperative and postoperative magnetic resonance imaging(MRI), computed tomography (CT), echocardiography and/or angiography datain 12 patients with mycotic aneurysm or prosthetic graft infection, in whomcryopreserved arterial homografts were used to replace infected segments ofmajor thoracic and abdominal vessels. The hospital mortality was 8.3%. Theaverage postoperative hospital stay was 18 +/- 14.5 days (6 to 45);antibiotic treatment was continued for 31 +/- 12 days (4 to 42). During themean follow-up time of 18.6 +/- 12.8 months (2 to 48) two patients died,but only one (9%) was homograft-related. Recurrence of infection, sutureline problems or homograft stenosis or aneurysm were not observed.Therefore, in situ replacement with cryopreserved arterial homografts is aneffective treatment for mycotic aneurysms and graft infection of thoracicaorta, abdominal aortic/iliac vessels and infected extra-anatomic bypass.This operative technique has a low early and late mortality, obviates theneed for complex extra-anatomic reconstruction, allows safe in situ repair,reduces postoperative antibiotic requirements, shortens the hospital stayand renders early or medium-term reoperations unnecessary.

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