Abstract：
OBJECTIVE: Peripheral arterial infections are rare and difficult to treat when an in situ reconstruction is required. Autologous vein (AV) is 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.
METHODS: 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.
RESULTS: A total of 42 patients (28 CAA, 14 AV) with a mean age of 65 and 69 years, respectively, were identified. 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, five femoral patches, four carotid-subclavian grafts, one carotid-carotid graft, and one 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%). Preoperative blood cultures were positive in 17 patients (41%). AVs included saphenous vein in eight and femoral vein in six. Intraoperative cultures were negative in nine patients (23%), polymicrobial in eight (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 post-discharge. 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 AV group (7%). Freedom from graft-related reintervention rates at 3 years were 82% and 92% in the CAA and AV group, respectively (P = .12). Survival rates at 1 and 3 years were 85% and 65% in the CAA group and 92% and 84% in the AV group (P = .13). Freedom from loss of primary patency was similar with 3-year rates of 77% and 83% in the CAA and AV group, respectively (P = .25). No patients in either group were diagnosed with reinfection.
CONCLUSIONS: CAAs are an alternative conduit for peripheral arterial reconstructions when AV is not available. Although there was a trend towards higher graft-related reintervention rates in the CAA group, patency is similar and reinfection is rare.
METHODS: 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.
RESULTS: A total of 42 patients (28 CAA, 14 AV) with a mean age of 65 and 69 years, respectively, were identified. 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, five femoral patches, four carotid-subclavian grafts, one carotid-carotid graft, and one 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%). Preoperative blood cultures were positive in 17 patients (41%). AVs included saphenous vein in eight and femoral vein in six. Intraoperative cultures were negative in nine patients (23%), polymicrobial in eight (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 post-discharge. 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 AV group (7%). Freedom from graft-related reintervention rates at 3 years were 82% and 92% in the CAA and AV group, respectively (P = .12). Survival rates at 1 and 3 years were 85% and 65% in the CAA group and 92% and 84% in the AV group (P = .13). Freedom from loss of primary patency was similar with 3-year rates of 77% and 83% in the CAA and AV group, respectively (P = .25). No patients in either group were diagnosed with reinfection.
CONCLUSIONS: CAAs are an alternative conduit for peripheral arterial reconstructions when AV is not available. Although there was a trend towards higher graft-related reintervention rates in the CAA group, patency is similar and reinfection is rare.
摘要：
目的：当需要原位重建时，外周动脉感染是罕见且难以治疗的。自体静脉(AV)在许多情况下是选择的导管。然而,冷冻保存的动脉同种异体移植物（CAA）是一种选择。我们旨在评估我们在原发性和继发性外周动脉感染中使用CAA和AV进行重建的经验。
方法：回顾性分析2002年1月至2022年8月接受CAA或AV重建的外周动脉感染患者的数据。排除主动脉或髂感染患者。
结果：42例患者（28例CAA，14AV)，平均年龄68岁和69岁，分别,已确定。31例患者（74％）为继发性感染，11例（26％）为原发性感染。继发感染包括10例股-股移植物，10股pop或股骨远端移植物，5个股骨补片，4个颈动脉-锁骨下移植,1个颈动脉-颈动脉移植物和1个感染的颈动脉斑块。原发感染部位包括6个股骨，3窝和2锁骨下动脉。在下肢感染的患者中，相关的腹股沟感染出现在19例(56%).术前血培养阳性17例(41%)。AVs包括8例隐静脉和6例股静脉。9例(23%)患者术中培养均为阴性,8例（21%）的多微生物和22例（56%）的单微生物。30天死亡率发生在四名患者（10％），2由于多系统器官衰竭，1由于移植物破裂导致急性失血和心肌梗塞，1由于不明原因出院后。CAA和AV组的中位随访时间为20个月和46个月。分别。在CAA组的6例患者（21％）和自体静脉组的1例患者（7％）中进行了移植物相关的再干预。在CAA和AV组中，3年与移植物相关的再干预的自由度分别为82％和92％，分别(p=0.12)。CAA组的1年和3年生存率分别为85％和65％，AV组分别为92％和84％（p=0.13）。在CAA和AV组中，原发性通畅性丧失的自由相似，3年率分别为77％和83％。分别(p=0.25)。两组患者均未诊断为再感染。
结论：当自体静脉不可用时，CAAs是外周动脉重建的替代导管。虽然CAA组有较高的移植相关再干预率的趋势，通畅性相似，再感染很少见。
方法：回顾性分析2002年1月至2022年8月接受CAA或AV重建的外周动脉感染患者的数据。排除主动脉或髂感染患者。
结果：42例患者（28例CAA，14AV)，平均年龄68岁和69岁，分别,已确定。31例患者（74％）为继发性感染，11例（26％）为原发性感染。继发感染包括10例股-股移植物，10股pop或股骨远端移植物，5个股骨补片，4个颈动脉-锁骨下移植,1个颈动脉-颈动脉移植物和1个感染的颈动脉斑块。原发感染部位包括6个股骨，3窝和2锁骨下动脉。在下肢感染的患者中，相关的腹股沟感染出现在19例(56%).术前血培养阳性17例(41%)。AVs包括8例隐静脉和6例股静脉。9例(23%)患者术中培养均为阴性,8例（21%）的多微生物和22例（56%）的单微生物。30天死亡率发生在四名患者（10％），2由于多系统器官衰竭，1由于移植物破裂导致急性失血和心肌梗塞，1由于不明原因出院后。CAA和AV组的中位随访时间为20个月和46个月。分别。在CAA组的6例患者（21％）和自体静脉组的1例患者（7％）中进行了移植物相关的再干预。在CAA和AV组中，3年与移植物相关的再干预的自由度分别为82％和92％，分别(p=0.12)。CAA组的1年和3年生存率分别为85％和65％，AV组分别为92％和84％（p=0.13）。在CAA和AV组中，原发性通畅性丧失的自由相似，3年率分别为77％和83％。分别(p=0.25)。两组患者均未诊断为再感染。
结论：当自体静脉不可用时，CAAs是外周动脉重建的替代导管。虽然CAA组有较高的移植相关再干预率的趋势，通畅性相似，再感染很少见。
