Peripheral Arterial Infections: Experience with Cryopreserved Allografts

To assess outcomes of peripheral arterial reconstruction using cryopreserved allograft (CPA) in infected or contaminated operative fields.

A retrospective review was performed on patients who underwent peripheral arterial reconstruction using CPA in infected/contaminated fields at a quaternary medical center (2000-2025). CPA venous reconstruction, dialysis access, and bypass in non-infected and non-contaminated fields were excluded. Outcomes assessed included: overall survival, CPA-related complications (graft reinfection, stenosis/thrombosis, degeneration, dehiscence, rupture), limb loss, and CPA-related reinterventions.

Thirty-five patients (23 male) with median age of 67 years old in whom 38 CPAs were implanted were included. Indications for CPA use were: infected prosthetic graft (58%), infected bovine patch (21%), infected stent graft (8%), native arterial infections (8%), and vascular injuries in contaminated fields (5%). Vascular reconstructions involved the lower extremity in 87% of cases, the upper extremity in 11%, and the carotid artery in 3%. At a median follow-up of 34 months, CPA-related complications included stenosis / thrombosis (18%), reinfection (8%), rupture (3%), and anastomotic dehiscence (3%). Freedom from CPA-related complication was 74% at 1 year and 61% at 3 years. Prompt reintervention (n=11) resulted in an overall low amputation rate at 3 years (n=2). One-year and 3-year survival rates were both 77%, respectively.

CPA is a viable conduit option for peripheral arterial reconstruction in infected or contaminated fields. Occurrence of CPA-related complications underscores the need for careful surveillance and longitudinal follow-up. These data support the use of CPA as a viable conduit in complex cases where alternative options are limited, demonstrating favorable amputation-free survival, though with some need for reintervention.