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) are 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. Outcome measures were overall survival, graft-related reintervention, and patency. A total of 42 patients (28 CAA and 14 AV) with a mean age of 68 and 69 years, respectively, were identified. Baseline characteristics are presented in Table I. 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, 5 femoral patches, 4 carotid-subclavian grafts, 1 carotid-carotid graft, and 1 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%) patients. Preoperative blood cultures were positive in 17 (41%) patients. AVs included saphenous vein in eight and femoral vein in six. Intraoperative cultures were negative in 9 patients (23%), polymicrobial in 8 (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 after discharge (Table II). The 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 autologous vein group (7%). Freedom from graft-related reintervention rates at 3 years were 82% and 92% in the CAA and AV group, respectively (P = .23). Survival rates at 1 and 3 years were 85% and 65% in the CAA group and 92% and 84% in the AV group (P = .12). Freedom from loss of primary patency rates were similar with 3-year rates of 77% and 83% in the CAA and AV group, respectively (P = .24). No patients in either group was diagnosed with reinfection. CAAs are an acceptable conduit for peripheral arterial reconstructions when autologous veins are not available. Although there is a trend toward higher graft-related reintervention rates in the CAA group, patency is similar and reinfection is rare.Table IBaseline characteristicsVariableCAA (n = 28)Autologous vein (n = 14)Male, No (%)16 (57.1)10 (71.4)Age, mean (SD), years65 (18)69 (10)BMI, mean (SD)28.4 (6.1)28.3 (7.9)Comorbidities, No. (%) Hypertension21 (77.8)10 (71.4) Peripheral artery disease18 (66.7)7 (50.0) Hyperlipidemia18 (66.7)7 (50.0) Coronary artery disease12 (44.4)5 (35.7) Current or previous smoking history18 (66.7)9 (64.3) Chronic kidney disease7 (25.9)6 (42.9) Prior CVA or TIA8 (29.6)1 (7.1)Positive preoperative bloodstream, No. (%)10 (35.7)7 (50.0)Preoperative antibiotic administration, No. (%)21 (75.0)13 (92.9)Groin infection, No. (%)13 (59.1)6 (46.2)Preoperative drainage, No. (%)4 (14.3)2 (14.3)Secondary infection, No. (%)22 (78.6)9 (64.3) Femoral-femoral graft, No. (%)5 (22.7)5 (55.6) Femoropopliteal/femoral-distal graft, No. (%)8 (36.4)2 (22.2) Femoral artery patch, No. (%)4 (18.2)1 (11.1) Carotid-subclavian graft, No. (%)4 (18.2)0 Carotid-carotid graft, No. (%)1 (4.5)0 Carotid artery patch, No. (%)0 ()1 (11.1)Primary infection, No. (%)6 (21.4)5 (35.7) Femoral artery, No. (%)4 (66.7)2 (40.0) Popliteal artery, No. (%)03 (60.0) Subclavian artery, No. (%)2 (33.3)0BMI, Body mass index; CAA, cryopreserved arterial allograft; CVA, cerebrovascular accident; SD, standard deviation; TIA, transient ischemic attack. Open table in a new tab Table IIPerioperative and follow-up dataVariableCAAAutologous veinHospital stay, days11.25 (10.1)8.9 (4.3)30-day mortality, No. (%)3 (10.7)1 (7.1)In-hospital/30-day complications, No. (%) Multisystem organ failure2 (7.1)1 (7.1) Myocardial infarction2 (4.5)0 Stroke1 (6.8)0 Wound dehiscence requiring reintervention5 (13.6)1 (7.1)3-year outcomes, % Survival65.183.9 Freedom from graft-related reintervention82.091.7 Freedom from loss of primary patency76.883.3CAA, Cryopreserved arterial allograft. Open table in a new tab