SS21 - Cryopreserved Arterial Allografts versus Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Grafts

Objectives: Aortic and iliac graft infections remain difficult clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in-situ reconstruction. The aim of this study was to compare the safety and effectiveness of CAA versus RSD in this setting.

Methods: Data from consecutive patients with aortic and iliac graft infections undergoing in-situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcome was overall survival. Secondary outcomes included graft-related reintervention, reinfection, perioperative mortality and major morbidity.

Results: 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 patients CAA group and 19 patients RSD group). Graft-enteric fistulas were more common in the RSD group (48.8% RSD, 29.0% CAA, p=0.014). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD, p=0.0002) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively. 30-day/in-hospital mortality was similar between the groups (7.5% RSD, 7.2% CAA, p=1.00). One early graft-related death occurred on post-operative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD group, respectively. Overall survival at 5-years was similar at 59.2% in the RSD group and 59.0% in the CAA group (p=0.80). Freedom from graft-related reintervention (Fig 1) at 1 and 5-years was 81.3% and 66.2% (CAA) vs. 95.6% and 92.5% (RSD, p=0.0157). Indications for reintervention in the CAA group included stenosis (5), pseudoaneurysm (4), occlusion (2), graft-limb kinking (1), rupture (1). In the RSD group indications for reintervention included reinfection (3), occlusion (1), endoleak (1), omental coverage (1) and rupture (1). Freedom from reinfection (Fig 2) at 1 and 5-years was 98.3% and 94.9% (CAA) vs. 92.5% and 87.2% (RSD, p=0.1143). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively required graft explantation due to reinfection.

Conclusions: Aorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients’ for in-situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and re-interventions.