Experimental aortic replacement with a vascularized tissue graft

Prosthetic graft infection in the aortic position remains a catastrophic complication of aortic replacement. In an effort to incorporate the advantages of vascularized tissue into aortic replacement, the practionally of infrarenal aortic replacement was investigated in dogs by a vascularized, musculofascial, pedicle graft. Eight dogs underwent laparotomy, and the left rectus abdominus muscle, its posterior rectus sheath, and underlying peritoneum were used to construct a tube graft based on the inferior epigastric vascular pedicle. A 2- to 4-cm section of the infrarenal aorta was resected, and the tube graft was interposed. Aortography documented graft patency immediately and at 1,6, and 10 months. Gross and histologic examination of the grafts at one month revealed viable skeletal muscle in the pedicle graft, with a thin layer of fibrin deposition on the luminal surface. Ten months after insertion, the microscopic examination against revealed patent vessels in the graft and a neoendothelial layer that lined the luminal surface of the graft. Successful replacement of the dog infrarenal aorta can be performed using a tube graft as part of a vascularized, musculofascial, pedicle flap. The potential for its use in the infected field is intriguing and deserves further study.