Treatment of Aortic Graft Infection with Cryopreserved Aortic Allografts

Reconstruction alternatives following removal of an infected aortic graft bear a high morbidity and mortality rate. Recent reports suggest that cryopreserved tissue may be implanted in infected fields and, therefore, may be suitable for replacement of infected aortic grafts. We report two cases of aortic replacement with cryopreserved allografts. Case 1: A 60-year-old woman presented with 6 months of right groin pain and a 30-1b. weight loss. She underwent aortobifemoral bypass in 1981 for occlusive disease, with revisions in 1983 and 1985. Computed tomography (CT) and indium-111 WBC scan suggested aortobifemoral graft infection. The aortobifemoral graft was removed and replaced with a cryopreserved aortoiliac allograft. Postoperatively, she had a left hemispheric stroke with right arm weakness. She recovered well, and 7 months later was doing well, with palpable distal pulses and no evidence of recurrent infection on CT scan. Case 2: Two years after placement of an aortobiiliac graft for aneurysmal disease, a 77-year-old man presented with sequelae of septic emboli. There was no fat plane between the proximal graft and small bowel on CT scan. Indium-111 WBC scan suggested aortic graft infection. Abdominal exploration confirmed aortic graft-enteric erosion, with a defect in the proximal jejunum, which was repaired. The infected graft was removed and the aorta replaced with a cryopreserved aortic allograft. He had no postoperative complications. Thirteen months after surgery, he is asymptomatic, without complications or evidence of infection on CT or WBC scans. Aortic cryopreserved allografts may be a feasible alternative for replacement of infected aortic grafts. Our early experience has been promising, but long-term follow-up is necessary to assess secondary aneurysmal or thrombotic changes in these grafts.