Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
J Vasc Surg. 2021 Jul;74(1):268-275. doi: 10.1016/j.jvs.2020.12.070. Epub 2021 Mar 1.
Different graft materials have been proposed for in situ reconstruction in the setting of vascular graft infection (VGI). We analyzed the long-term outcomes after in situ aortoiliac reconstruction with cryopreserved allografts.
We performed a retrospective analysis of patients who had undergone in situ aortoiliac reconstruction with cryopreserved arterial allografts for VGI from 2000 to 2015. The end points were the perioperative and long-term mortality and graft-related complications, including stenosis, occlusion, pseudoaneurysm, and reinfection.
A total of 33 patients (91% male) with a median age of 67 years (range, 53-83 years) had undergone in situ aortoiliac reconstruction with cryopreserved allografts. The 30-day mortality was 6% (n = 2); both deaths were related to the allograft (one early allograft-enteric fistula and one graft rupture). Another two patients had experienced early (≤30 days) graft-related events (one allograft-enteric fistula and one graft limb occlusion), for an early graft-related complication rate of 12% (n = 4). Of the 31 discharged patients, 13 (42%) had died after a median of 47 months (range, 2-97 months). The median follow-up for the 18 remaining patients was 96 months (range, 10-146 months). The estimated survival at 1, 3, and 5 years was 88%, 81%, and 66%, respectively. Nine patients (29%) had experienced at least one of the following graft-related events during follow-up, including graft stenosis requiring intervention in five (16%), graft occlusion in four (13%), pseudoaneurysm in three (10%), and reinfection in two patients (6%). The estimated freedom from any first graft-related event at 1, 3, and 5 years was 78%, 71%, and 62%, respectively. The estimated primary patency and primary assisted patency at 1 and 3 years was 87% and 79%, and 90% and 83%, respectively.
In situ aortoiliac reconstruction with cryopreserved allografts to treat VGI was associated with relevant perioperative graft-related complications. Although the reinfection rate was acceptable, other graft-related complications were frequent in the long term, in particular, graft occlusion and stenosis.
在血管移植物感染（VGI）的情况下，已经提出了不同的移植物材料用于原位重建。我们分析了冷冻保存同种异体移植物用于 VGI 时的原位腹主动脉重建的长期结果。
我们对 2000 年至 2015 年间接受冷冻保存动脉同种异体移植物原位腹主动脉重建治疗 VGI 的患者进行了回顾性分析。终点为围手术期和长期死亡率以及移植物相关并发症，包括狭窄、闭塞、假性动脉瘤和再感染。
共有 33 名（91%为男性）中位年龄 67 岁（范围，53-83 岁）的患者接受了冷冻保存同种异体移植物的原位腹主动脉重建。30 天死亡率为 6%（n=2）；两次死亡均与移植物有关（一次早期移植物-肠瘘，一次移植物破裂）。另外两名患者在早期（≤30 天）发生了移植物相关事件（一次移植物-肠瘘和一次移植物支闭塞），早期移植物相关并发症发生率为 12%（n=4）。31 名出院患者中，中位随访 47 个月（范围，2-97 个月）后有 13 名（42%）死亡。其余 18 名患者的中位随访时间为 96 个月（范围，10-146 个月）。估计 1、3 和 5 年的生存率分别为 88%、81%和 66%。9 名患者（29%）在随访期间至少经历了一次以下移植物相关事件，包括 5 名患者（16%）需要干预的移植物狭窄、4 名患者（13%）的移植物闭塞、3 名患者（10%）的假性动脉瘤和 2 名患者（6%）的再感染。估计 1、3 和 5 年时无任何首次移植物相关事件的患者比例分别为 78%、71%和 62%。估计 1 年和 3 年的原发性通畅率和原发性辅助通畅率分别为 87%和 79%，90%和 83%。
用冷冻保存同种异体移植物治疗 VGI 的原位腹主动脉重建与相关的围手术期移植物相关并发症有关。尽管再感染率是可以接受的，但其他移植物相关并发症在长期内较为常见，特别是移植物闭塞和狭窄。
