Editor's Choice - Cryopreserved Allografts for Arterial Reconstruction after Aorto-Iliac Infection: A Systematic Review and Meta-Analysis

Constantine N Antonopoulos; Nikolaos A Papakonstantinou; David Hardy; Sean P Lyden

doi:10.1016/j.ejvs.2019.03.003

Editor's Choice - Cryopreserved Allografts for Arterial Reconstruction after Aorto-Iliac Infection: A Systematic Review and Meta-Analysis

Eur J Vasc Endovasc Surg. 2019 Jul;58(1):120-128. doi: 10.1016/j.ejvs.2019.03.003. Epub 2019 Jun 12.

Authors

Constantine N Antonopoulos¹, Nikolaos A Papakonstantinou², David Hardy³, Sean P Lyden³

Affiliations

¹ Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital, Athens, Greece; Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address: kostas.antonopoulos@gmail.com.
² Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital, Athens, Greece.
³ Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA.

PMID: 31202580
DOI: 10.1016/j.ejvs.2019.03.003

Abstract

Objective: Native and aortic graft infections are rare, but they represent one of the most life threatening complications of vascular surgery. Several materials and surgical approaches have been developed so far. Among them, cryopreserved allografts have been proposed as a treatment option. A systematic review and meta-analysis was conducted to investigate the role of cryopreserved allografts for arterial reconstruction after aorto-iliac infection.

Methods: The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Patient baseline characteristics were investigated, along with 30 outcomes after use of cryopreserved arterial allografts for reconstruction after aorto-iliac infection. Pooled proportions with 95% CIs of outcome rates were calculated.

Results: A total of 31 studies, including 1,377 patients, finally participated in the meta-analysis. Among the early outcomes, 30 day mortality was 14.91% (95% CI 11.78-18.31). Peri-anastomotic rupture/allograft disruption rate was 5.90% (95% CI 2.77-9.88), while pooled aneurysmal degeneration/allograft dilatation was 4.99% (95% CI 1.60-9.68). A pooled rate of 3.11% (95% CI 1.60-4.98) was estimated for pseudoaneurysm formation after the use of cryopreserved arterial allografts, while the allograft thrombotic/stenotic complication rate and peri-anastomotic infection were 12.19% (95% CI 7.90-17.15) and 3.32% (95% CI 1.90-5.03), respectively. Mortality during follow up was 19.24% (95% CI 11.97-27.58), while allograft related mortality during follow up was 3.58% (95% CI 1.56-6.15). A pooled allograft related re-operation rate was estimated at 24.87% (95% CI 17.89-32.51).

Conclusions: The use of cryopreserved allograft seems to be a safe and durable option with acceptable outcomes for treatment of aorto-iliac infection.

Keywords: Allografts; Cryopreservation; Infection; Meta-analysis; Reconstructive surgical procedures; Review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Allografts
Aneurysm, Infected
Aorta, Abdominal / transplantation*
Blood Vessel Prosthesis / adverse effects
Blood Vessel Prosthesis Implantation / methods*
Cryopreservation*
Humans
Organ Preservation / methods*
Prosthesis-Related Infections / surgery*
Reoperation / methods
Transplantation, Homologous / methods
Treatment Outcome