Novel Prefabricated Bovine Pericardial Grafts as Alternate Conduit for Septic Aorto-Iliac Reconstruction.

Infection of prosthetic aortic grafts represents a serious complication with high morbidity and mortality. Replacement with autologous material is recommended, in absence thereof biological material should be favored. In this retrospective cohort study we evaluated short and mid-term results with the use of commercially available prefabricated bovine pericardium grafts (BPGs) used for the management of aortic graft infection or aortic reconstructive surgery in the presence of systemic infection.
A retrospective analysis of cases in which BPGs were used for aortic reconstruction in two vascular centers. Prefabricated vascular pericardium grafts were preferred over other biological reconstruction techniques in selected cases. Comorbidities, procedure related details, perioperative morbidity, clinical outcome and mortality were analyzed.
From 2014 to 2019 twenty-one patients received BPGs at two Austrian vascular centers. Median age was 63 years [IQR 55-71], patients were predominantly male (76%), median body mass index was 25.3 kg/m [IQR 21.7-27.3]. Major comorbidities featured arterial hypertension, peripheral artery disease, smoking and chronic pulmonary disease. Indications for surgery were vascular graft or endograft infection in 62% and aortic reconstruction in the presence of systemic infection in 38%. Three patients (14%) had aorto-enteric fistulae. Surgery was technically successful in all cases. Median follow-up was 21.6 months (IQR 6.0-34.6). Thirty-day mortality was 9.5%. One-year and two-year overall survival was 84 and 75%, respectively. 89% of patients remained free from recurrent infection, one of two re-infections remitted after treatment of the underlying focus. At 2 years primary and assisted primary patency rates were 86 and 94% respectively. No limbs were lost during follow-up.
Prefabricated bovine grafts represent a promising alternative for the management of aortic graft infections as well as for aorto-iliac reconstruction during systemic infection.

Copyright © 2020. Published by Elsevier Inc.