Cryopreserved Arterial Allografts Versus Autologous Vein for Arterial Reconstruction in Infected Fields

Peripheral arterial infections are rare and difficult to treat when an in situ reconstruction is required. Autologous veins (AVs) the conduit of choice many scenarios. However, cryopreserved allografts (CAAs) alternative. We aimed assess our experience with CAAs AVs for primary secondary peripheral infections. Data from patients undergoing CAA or AV January 2002 through August 2022 were retrospectively analyzed. Patients aortic- iliac-based excluded. Outcome measures overall survival, graft-related reintervention, patency. A total 42 (28 14 AV) a mean age 68 69 years, respectively, identified. Baseline characteristics presented Table I. Infections 31 (74%) 11 (26%). Secondary included 10 femoral-femoral grafts, femoropopliteal femoral-distal 5 femoral patches, 4 carotid-subclavian 1 carotid-carotid graft, infected carotid patch. Primary infection locations six femoral, three popliteal, two subclavian arteries. In lower-extremity infections, associated groin present 19 (56%) patients. Preoperative blood cultures positive 17 (41%) saphenous vein eight six. Intraoperative negative 9 (23%), polymicrobial 8 (21%), monomicrobial 22 (56%). Thirty-day mortality occurred four (10%), due multisystem organ failure, one graft rupture causing acute loss myocardial infarction, unknown cause after discharge (Table II). The median follow-up was 20 months 46 group, respectively. Graft-related reintervention performed group (21%) patient autologous (7%). Freedom rates at 3 years 82% 92% respectively (P = .23). Survival 85% 65% 84% .12). patency similar 3-year 77% 83% .24). No either diagnosed reinfection. acceptable reconstructions not available. Although there trend toward higher reinfection rare.Table IBaseline characteristicsVariableCAA (n 28)Autologous 14)Male, (%)16 (57.1)10 (71.4)Age, (SD), years65 (18)69 (10)BMI, (SD)28.4 (6.1)28.3 (7.9)Comorbidities, No. (%) Hypertension21 (77.8)10 (71.4) artery disease18 (66.7)7 (50.0) Hyperlipidemia18 Coronary disease12 (44.4)5 (35.7) Current previous smoking history18 (66.7)9 (64.3) Chronic kidney disease7 (25.9)6 (42.9) Prior CVA TIA8 (29.6)1 (7.1)Positive preoperative bloodstream, (%)10 (35.7)7 (50.0)Preoperative antibiotic administration, (%)21 (75.0)13 (92.9)Groin infection, (%)13 (59.1)6 (46.2)Preoperative drainage, (%)4 (14.3)2 (14.3)Secondary (%)22 (78.6)9 Femoral-femoral (%)5 (22.7)5 (55.6) Femoropopliteal/femoral-distal (%)8 (36.4)2 (22.2) Femoral patch, (18.2)1 (11.1) Carotid-subclavian (18.2)0 Carotid-carotid (%)1 (4.5)0 Carotid (%)0 ()1 (11.1)Primary (%)6 (21.4)5 artery, (66.7)2 (40.0) Popliteal (%)03 (60.0) Subclavian (%)2 (33.3)0BMI, Body mass index; CAA, allograft; CVA, cerebrovascular accident; SD, standard deviation; TIA, transient ischemic attack. Open table new tab IIPerioperative dataVariableCAAAutologous veinHospital stay, days11.25 (10.1)8.9 (4.3)30-day mortality, (%)3 (10.7)1 (7.1)In-hospital/30-day complications, Multisystem failure2 (7.1)1 (7.1) Myocardial infarction2 Stroke1 (6.8)0 Wound dehiscence requiring reintervention5 (13.6)1 (7.1)3-year outcomes, % Survival65.183.9 reintervention82.091.7 patency76.883.3CAA, Cryopreserved allograft.