Prosthetic vascular infection complicated or not by aortoenteric fistula: comparison of treatment with and without cryopreserved allograft (homograft).

OBJECTIVES: in patients with vascular prosthesis infection, to compare surgical outcome and long-term results of cryopreserved allograft implantations to conventional surgery. DESIGN: retrospective study. MATERIAL AND METHODS: two asynchronous series of 44 [series I: 1980-1994; 8 patients with aortoenteric fistula (AEF)] and 22 (series II: 1994-1997; 4 patients with AEF) patients were treated for prosthesis infection. All patients had prosthesis excision. In series I, there were 4 in situ reparations, 26 extra-anatomic bypass, 13 excision only, and one death at laparotomy. In series II, in situ cryopreserved allografts were implanted in all patients. RESULTS: operative mortality was 16% in series I and 13.6% in series II. For AEF patients, mortality was 37% in series I and 50% in series II. Among hospital survivors, infection-related late mortality was 13.5% in series I and 5% in series II. For AEF patients, late mortality was 20% in series I and 50% in series II. Incidence of reoperations was 54% in series I and 10.5% in series II (p<0.01). Hospital stay was 47.2+/-26.4 days in series I and 16.6+/-11.5 days in series II (p<0.001). CONCLUSIONS: compared to conventional treatment, incidence of reoperations and length of hospital stay are significantly decreased after cryopreserved allograft implantation. However, closure of aortic stump and extra-anatomic bypass gives better results for patients with AEF.