Management of infected aortic grafts: development of less invasive surgery using cryopreserved homografts.

Abstract

Aortic graft infection is associated with significant mortality and morbidity. Total graft replacement with homografts provides an effective treatment. Partial graft replacement at the site of infection may simplify the surgical procedure. Between January 1991 and December 1996, homografts were used in 18 patients (mean age, 61+/-12 years; range 41-85) with thoracic (4/18; 22%) or abdominal (14/18; 78%) aortic graft infection. Sepsis was present in 14 patients (78%); 6 (33%) had various aortic fistulae. Total graft replacement using homografts was performed in 14 (78%), and partial graft replacement at the site of infection in 4 patients (22%). Hospital mortality was 11%. During the follow-up period of 22+/-15 months (range, 12-65) there was 1 infection and 1 homograft-related late death after complete homograft replacement, and 1 percutaneous vascular stent placement after partial graft replacement. No other instances of reinfection, suture line rupture or anastomotic aneurysms were observed. Total graft replacement with homografts provides an effective treatment for infected aortic grafts. Partial graft replacement at the site of infection is feasible and safe.