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Aortic infection is a challenging condition. Fortunately, surgical revision of infected aorta with in situ reconstruction can provide long-term cure. The material for aortic repair remains an area of debate. The Omniflow II (LeMaitre Vascular, Burlington, Mass) prosthesis is a biosynthetic graft made to resist long-term degeneration and allows growth of host tissue with reduction of the risk of arterial infection. It has already been used for peripheral bypass with very low infection rates. Herein, we describe an original case of first-line native aorta replacement by a straight Omniflow II biologic prosthesis for infected aortic aneurysm. Keywords: Aorta, Infection, Biosynthetic graft

Objective Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. Material and methods A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). Results The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. Conclusion This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.

Virologic analysis of tissues from a patient with giant cell arteritis (GCA) who was treated with corticosteroids and died of extensive necrotizing granulomatous arteritis revealed widespread varicella-zoster virus (VZV) antigen in multiple large arteries. Long-term treatment with corticosteroids likely potentiated VZV infection. Acknowledgment: The authors thank Marina Hoffman for editorial review and Cathy Allen for word processing and formatting.

The treatment of mycotic abdominal aortic aneurysms remains a significant surgical challenge associated with significant morbidity and mortality. In the following case report, we describe our successful management of a patient with a mycotic abdominal aortic aneurysm using two cryopreserved superficial femoral artery allografts (available from the UK NHS tissue bank) to create a Y-shaped allograft to permit immediate aortic reconstruction after surgical debridement. To our knowledge, this is the first time such a reconstruction has been reported in the literature.

Hemostasis obtained by manual compression after femoral artery catheterization results in consistently low rates of major complications. A rare complication of femoral artery catheterization is arterial infection. Its occurrence after diagnostic angiography using manual compression has not been reported. We report two cases of femoral arterial infection after uneventful diagnostic catheterization in nonimmunocompromised patients using the perclose percutaneous arterial closure device. Our cases are representative of perclose associated infections, with delayed presentation of a staphylococcal arterial infection requiring arterial debridement and reconstruction. This article indicates that perclose use carries a risk of severe arterial infection. Surgeons should be aware of the potential infectious complications associated with perclose use and the need for aggressive treatment. (J Vasc Surg 2001;34:983-5.)

To the Editor: The article by Gieffers et al1 in the January 23, 2001, issue of Circulation reiterates the general belief that lungs harbor Chlamydia pneumoniae organisms that are continuously released into the bloodstream. It is suggested that these organisms are carried by lung macrophages, which repeatedly infiltrate and infect atherosclerotic lesions. There are certain pathological features of human atherosclerotic lesions that suggest that this mechanism may not be entirely correct. Chlamydia pneumoniae usually causes mild upper respiratory tract infections. If the …

Percutaneous arterial closure devices allow earlier mobilization and discharge of patients after arterial catheterization than manual compression for achieving puncture site hemostasis. Our case is representative of Perclose associated infections; our patient had a delayed presentation of a staphylococcal arterial infection that required arterial debridement and reconstruction. Physicians should be aware of this uncommon, but serious complication to expedite the evaluation and treatment of patients with suspected infections that can arise from using these devices. (Korean Circulation J 2006;36:762-763)

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.Eur J Vasc Endovasc Surg 25, 416-423 (2003)

OBJECTIVE: Infection of synthetic grafts or femoral arteries in the groin is a challenging problem to treat. Femoro-popliteal vein (FPV) is an ideal conduit but extensive replacement of infected aortic grafts with FPV has been associated with significant morbidity. The aim of this study was to evaluate early and long-term outcome of limited replacement with FPV of infected femoral arteries/grafts in the groin.