Early and Long-Term Outcomes of Cryopreserved Arterial Allograft Reconstruction in Concomitant Aortic and Spinal...

To report early and long-term outcomes of aortic reconstruction using cryopreserved arterial allograft in patients with concomitant aortoiliac and spine infections.

Patients who underwent surgery for thoracic or abdominal aortic infection associated with spondylodiscitis between October 2004 and July 2024 were included. Outcomes included perioperative mortality rates and complications, as well as long term mortality rates, aortic-related reinterventions, and reinfections.

Twenty-six consecutive patients were identified. Thirteen of them (50%) presented with native aortoiliac infection, and 13 (50%) with aortoiliac infection secondary to orthopedic or vascular implants. One patient had a secondary aortoenteric fistula following prior open aortic repair. Pathogens were identified in 23 patients (88%). Most common pathogens were Escherichia coli (n = 6, 23%) and Staphylococcus aureus (n = 5, 19%). All patients were treated with cryopreserved arterial allografts. The orthopedic approach was conservative in 9 patients (35%), consisted in bone debridement in 14 patients (54%), and arthrodesis in 6 (23%). Bone grafting was performed in 10 patients (38%). Several patients underwent combined procedures (debridement followed by arthrodesis or bone grafting). In-hospital mortality was 15% (n = 4). During a median follow-up of 35.5 (4.5-85.4) months, overall mortality from all cause was 46% (n = 12). The median time to reinfection was 4 (2.5-4) months, and the median time to aortic reintervention was 4.2 (1.8-14.6) months, with corresponding rates of 12% (n = 3) and 19% (n = 5), respectively.

The management of concomitant aortic infection and spondylodiscitis requires a combined strategy of prolonged antibiotic therapy, vascular reconstruction, and vertebral surgery. In situ reconstruction with cryopreserved arterial allografts, combined with orthopedic care, appears feasible and effective. Our findings-based on the largest cohort to date-show perioperative outcomes comparable to those observed in patients with isolated aortic or spinal infections. Further studies are needed to refine treatment strategies for this rare condition.