engleski

Long term follow-up of infrarenal abdominal aortic reconstruction with cryopreserved arterial homograft for prosthetic graft infection

Aim: Aortic graft infection is one of the most challenging complications in vascular surgery. Total excision of the infected prosthesis and in situ arterial reconstruction with an infection-resistant graft (such as cadaveric cryopreserved homografts) has replaced extra-anatomic bypass as the therapy of choice. Methods: case-report Results: A 76-year-old male was admitted for a contained rupture of the infrarenal AAA. The abdominal and back pain started four days prior, when he was examined in the urology clinic, and treated with analgesics. Open AAA repair with straight silver-coated vascular graft was performed. Five weeks following AAA reconstruction the patient presented with high fever and chills. CT aortography showed inhomogeneous fluid and gas collection in the residual aneurysmatic sac, surrounding the prosthesis. During re-operation, the infected prosthesis was excised and the aorta was reconstructed in situ using cryopreserved thoracic artery homograft. Bacteroides and Streptococcus species were isolated from mural thrombus culture, and were sensitive to standard antibiotics. A course of parenteral Vancomycin and Meropenem, followed by oral Phenoxymethylpenicillin 1500 mg three times a day were prescribed for 4 weeks, and the patient was discharged. Eight-year follow-up is uneventful. Conclusion: The gold standard for aortic graft infection treatment is still unknown. Various substitute materials for in situ repair, including autogenous veins, cryopreserved arterial homografts (CAH), and rifampicin-bonded, amikacin-loaded grafts have been used, with differing results. Advanced methods of cryopreservation and decontamination have resulted in better homograft wall viscoelastic and properties, but the incidence of long-term homograft degeneration (due to mechanical or immunological factors) remains unknown due to lack of patients with long-term follow-up. Although the short-term results after homograft implantation are generally good, no level 1 randomized trials are available, and a Cochrane Vascular Group systematic review is currently underway.

aorta ; aneurysm ; infrarenal aortic aneurysm ; cryopreserved arterial homograft

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