Bovine pericardial patch repair in infected fields

Objective Bovine pericardial patches (BPP) are frequently used for arterial reconstruction, but little data exist regarding their ability to resist infection. We hypothesize that BPP would provide a reasonable alternative to autologous vein patches in infected fields. Methods We used BPP to repair 51 arteriotomies (25 brachial, 23 femoral, three popliteal) in 48 consecutive patients (mean age, 68 years; 65% men, 75% diabetic, 67% dialysis dependent) undergoing removal of infected (33 gram-positive, three gram-negative, eight mixed flora, and four culture-negative) polytetrafluoroethylene grafts (35 arteriovenous grafts, nine femoral-distal bypasses, and four femoral patch angioplasties) between January 2007 and January 2011. Patient records were retrospectively reviewed and outcomes, including death, rupture, secondary reconstruction, and infection, were recorded. Results Over a mean follow-up of 2.1 years (range, 3-48 months), 50 of 51 patches remained in place without evidence of recurrent infection, rupture, or revision. One patient had acute rupture of a popliteal arteriotomy 1 week postrepair and had subsequent ligation and above-knee amputation. Eight of the 48 patients died from unrelated causes during follow-up (three withdrew from dialysis, three myocardial infarction, and two unknown). Conclusions BPP provide a durable alternative to saphenous vein for arterial reconstruction following removal of infected arterial grafts.