Infezioni protesiche nella chirurgia vascolare ricostruttiva

Introduction: We report a retrospective analysis of medium and long-term results about in situ reconstruction with cryopreserved arterial allograft (CAA) for aorto-iliac prosthetic infections. Material and methods: From January 2002 to December 2012, 25 patients with diagnoses of aorto-iliac prosthetic infection, underwent in situ arterial allograft replacement at the Department of Vascular Surgery, Santa Chiara Hospital, Trento. All patients were followed by clinical examination and CT at 1 and 6 months during the first year, thereafter by yearly duplex scanner and CT-scan in selected cases. Mean follow-up was 46 months (range 2-112); 3 patients were lost at follow-up. Results: At the explorative laparotomy 9 patients (36%) showed an aorto-enteric fistula (AEF). Surgical in situ reconstruction consisted of 5 aorto-aortic, 4 aorto-bisiliac, 11 aorto-bifemoral, 3 aorto-iliac with controlateral femoral anastomoses and 2 iliac-femoral by-passes. One patient (4%) needed early allograft removal and axillobifemoral reconstruction due to recurrent AEF. Overall post-operative mortality rate was 24%; one patient (4%) died for haemorrhagic shock due to homograft rupture, other five patients (20%) died for septic shock caused by persistent enteric fistula. Among the 18 patients at follow-up, two reinterventions (11%) were required: one due to graft thrombosis and recurrent, the other one due to proximal anastomoses. No major limb amputations were recorded. Conclusions: In our experience in situ reconstruction with cryopreserved arterial homograft showed low morbidity and mortality rates and should be considered a valid option for the treatment of abdominal aortic prosthetic infections.