Tabiei Armin, Cifuentes Sebastian, Colglazier Jill J, Shuja Fahad, Kalra Manju, Mendes Bernardo C, Schaller Melinda S, Rasmussen Todd E, DeMartino Randall R
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
J Vasc Surg. 2024 Apr;79(4):941-947. doi: 10.1016/j.jvs.2023.12.011. Epub 2023 Dec 13.
Peripheral arterial infections are rare and difficult to treat when an in situ reconstruction is required. Autologous vein (AV) is the conduit of choice in many scenarios. However, cryopreserved arterial allografts (CAAs) are an alternative. We aimed to assess our experience with CAAs and AVs for reconstruction in primary and secondary peripheral arterial infections.
Data from patients with peripheral arterial infections undergoing reconstruction with CAA or AV from January 2002 through August 2022 were retrospectively analyzed. Patients with aortic- or iliac-based infections were excluded.
A total of 42 patients (28 CAA, 14 AV) with a mean age of 65 and 69 years, respectively, were identified. Infections were secondary in 31 patients (74%) and primary in 11 (26%). Secondary infections included 10 femoral-femoral grafts, 10 femoropopliteal or femoral-distal grafts, five femoral patches, four carotid-subclavian grafts, one carotid-carotid graft, and one infected carotid patch. Primary infection locations included six femoral, three popliteal, and two subclavian arteries. In patients with lower extremity infections, associated groin infections were present in 19 (56%). Preoperative blood cultures were positive in 17 patients (41%). AVs included saphenous vein in eight and femoral vein in six. Intraoperative cultures were negative in nine patients (23%), polymicrobial in eight (21%), and monomicrobial in 22 (56%). Thirty-day mortality occurred in four patients (10%), two due to multisystem organ failure, one due to graft rupture causing acute blood loss and myocardial infarction, and one due to an unknown cause post-discharge. Median follow-up was 20 months and 46 months in the CAA and AV group, respectively. Graft-related reintervention was performed in six patients in the CAA group (21%) and one patient in the AV group (7%). Freedom from graft-related reintervention rates at 3 years were 82% and 92% in the CAA and AV group, respectively (P = .12). Survival rates at 1 and 3 years were 85% and 65% in the CAA group and 92% and 84% in the AV group (P = .13). Freedom from loss of primary patency was similar with 3-year rates of 77% and 83% in the CAA and AV group, respectively (P = .25). No patients in either group were diagnosed with reinfection.
CAAs are an alternative conduit for peripheral arterial reconstructions when AV is not available. Although there was a trend towards higher graft-related reintervention rates in the CAA group, patency is similar and reinfection is rare.
外周动脉感染较为罕见，在需要原位重建时治疗困难。自体静脉（AV）在许多情况下是首选的血管 conduit。然而，冷冻保存的动脉同种异体移植物（CAA）是一种替代选择。我们旨在评估使用CAA和AV进行原发性和继发性外周动脉感染重建的经验。
回顾性分析2002年1月至2022年8月期间接受CAA或AV重建的外周动脉感染患者的数据。排除主动脉或髂动脉感染患者。
共确定42例患者（28例使用CAA，14例使用AV），平均年龄分别为65岁和69岁。31例患者（74%）为继发性感染，11例（26%）为原发性感染。继发性感染包括10例股-股移植物、10例股腘或股-远端移植物、5例股部补片、4例颈动脉-锁骨下动脉移植物、1例颈-颈移植物和1例感染的颈动脉补片。原发性感染部位包括6例股动脉、3例腘动脉和2例锁骨下动脉。在下肢感染患者中，19例（56%）伴有腹股沟感染。17例患者（41%）术前血培养阳性。AV包括8例大隐静脉和6例股静脉。9例患者（23%）术中培养阴性，8例（21%）为多菌感染，22例（56%）为单菌感染。4例患者（10%）发生30天死亡率，2例死于多系统器官衰竭，1例因移植物破裂导致急性失血和心肌梗死，1例出院后死因不明。CAA组和AV组的中位随访时间分别为20个月和46个月。CAA组6例患者（21%）和AV组1例患者（7%）进行了与移植物相关的再次干预。CAA组和AV组3年无移植物相关再次干预率分别为82%和92%（P = 0.12）。CAA组1年和3年生存率分别为85%和65%，AV组分别为92%和84%（P = 0.13）。CAA组和AV组3年原发性通畅率无损失分别为77%和83%（P = 0.25）。两组均无患者被诊断为再次感染。
当无法获得AV时，CAA是外周动脉重建的替代血管 conduit。尽管CAA组移植物相关再次干预率有升高趋势，但通畅率相似且再次感染罕见。
