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Cryopreserved Human Allografts for the Reconstruction of Aortic and Peripheral Prosthetic Graft Infection
Matteo Bossi1, Matteo Tozzi1, Marco Franchin1
1Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Insights
Cryopreserved human allografts (CHAs) offer a viable solution for vascular reconstruction in infected prosthetic grafts, demonstrating excellent limb salvage and stability. This study highlights their effectiveness with a low rate of adverse events.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Biomaterials Science
Background:
- Prosthetic graft infections pose significant challenges in vascular reconstruction.
- Cryopreserved human allografts (CHAs) represent a potential alternative for managing these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of CHAs in patients with infected aortic and peripheral prosthetic grafts.
- To present clinical outcomes and long-term stability of CHA use in this patient cohort.
Main Methods:
- Retrospective analysis of a single-center observational study.
- Complete removal of infected prosthetic graft material followed by reconstruction with CHAs.
- Anticoagulation therapy post-discharge and comprehensive follow-up including imaging.
Main Results:
- 21 patients (90% male, mean age 71±12 years) were treated.
- 100% limb salvage rate with no CHA-related deaths.
- Estimated freedom from CHA-related adverse events was 95% at 3 years; no rupture, degeneration, or re-infection observed.
Conclusions:
- CHAs are a viable option for prosthetic graft infections, offering satisfactory clinical results.
- CHAs demonstrate favorable stability with a very low rate of adverse events during follow-up.
- The use of CHAs in vascular reconstruction for infected grafts is supported by positive clinical outcomes.
Abstract:
Background: This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods: This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year. Results: We treated 21 patients (90% men, n=19) with the mean age of 71±12 years and mean interval between the initial operation and replacement with CHA of 30 months [range, 1-216; interquartile range (IQR), 2-36]. In-hospital mortality was 14% (n=3); no CHA-related complication led to death. Limb salvage was 100%. No patient was lost at the median follow-up of 14 months (range, 2-61; IQR, 6-39). No rupture, aneurysmal degeneration, or re-infection occurred. Estimated freedom from CHA-related adverse events (95% confidence interval, 43-63) was 95% at 3 years. Conclusion: In our experience, CHAs are a viable option for prosthetic graft infections and provide satisfactory clinical results and favorable stability because of a very low rate of CHA-related adverse events during follow-up.
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