Peripheral artery reconstructions using cryopreserved arterial allografts in infected fields

Area of Science:

• Vascular Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Cryopreserved arterial allografts serve as viable alternatives for vascular reconstruction when autologous or prosthetic options are unsuitable.
• Their application in contaminated or infected surgical fields requires careful evaluation of outcomes.

Purpose of the Study:

• To assess the efficacy and safety of cryopreserved arterial allografts in peripheral vascular reconstructions within contaminated and infected surgical settings.
• To analyze graft patency, complication rates, and mortality associated with allograft use in challenging surgical environments.

Main Methods:

• A retrospective review of 57 patients undergoing peripheral vascular reconstruction with cryopreserved arterial allografts between 2002 and 2017.
• Indications included infected prosthetic removal, revascularization in contaminated fields, primary repair of infected arteries, and infected vascular closure devices.
• Data collected included demographics, procedural details, postoperative complications, and conduit patency, with a mean follow-up of 27.8 months.

Main Results:

• Fifty-seven reconstructions were performed, with a 30-day mortality of 9% (one death related to conduit insertion).
• The 30-day complication rate was 14%, including hemorrhage and graft infection.
• Late complication rates were 15.8%, encompassing graft infection, thrombosis, amputation, pseudoaneurysm, hemorrhage, and stenosis.

Conclusions:

• Cryopreserved arterial allografts are a valuable option for peripheral vascular reconstruction in infected or contaminated surgical fields.
• These grafts demonstrate acceptable resistance to early graft failure and reinfection, particularly when combined with muscle flap coverage.
• Late-onset conduit-related complications associated with these allografts appear to be infrequent.