Prosthetic vascular infection complicated or not by aortoenteric fistula: comparison of treatment with and without cryopreserved allograft (homograft).

Abstract

OBJECTIVES:

in patients with vascular prosthesis infection, to compare surgical outcome and long-term results of cryopreserved allograft implantations to conventional surgery.

DESIGN:

retrospective study.

MATERIAL AND METHODS:

two asynchronous series of 44 [series I: 1980-1994; 8 patients with aortoenteric fistula (AEF)] and 22 (series II: 1994-1997; 4 patients with AEF) patients were treated for prosthesis infection. All patients had prosthesis excision. In series I, there were 4 in situ reparations, 26 extra-anatomic bypass, 13 excision only, and one death at laparotomy. In series II, in situ cryopreserved allografts were implanted in all patients.

RESULTS:

operative mortality was 16% in series I and 13.6% in series II. For AEF patients, mortality was 37% in series I and 50% in series II. Among hospital survivors, infection-related late mortality was 13.5% in series I and 5% in series II. For AEF patients, late mortality was 20% in series I and 50% in series II. Incidence of reoperations was 54% in series I and 10.5% in series II (p<0.01). Hospital stay was 47.2+/-26.4 days in series I and 16.6+/-11.5 days in series II (p<0.001).

CONCLUSIONS:

compared to conventional treatment, incidence of reoperations and length of hospital stay are significantly decreased after cryopreserved allograft implantation. However, closure of aortic stump and extra-anatomic bypass gives better results for patients with AEF.

• Authors: J-P Lavigne, A Postal, P Kolh, R Limet
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 25 Issue 5 Pg. 416-23 (May 2003) ISSN: 1078-5884 [Print] England
• PMID: 12713780 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Aortic Diseases (complications, mortality, surgery)
• Blood Vessel Prosthesis (adverse effects)
• Chi-Square Distribution
• Cryopreservation
• Female
• Fistula (complications, mortality, surgery)
• Humans
• Male
• Middle Aged
• Odds Ratio
• Prosthesis Failure
• Prosthesis-Related Infections (complications, microbiology, mortality, surgery)
• Reoperation
• Transplantation, Homologous
• Treatment Outcome