Neoaortic Xenoprosthetic grafts for Treatment of Mycotic Aneurysms and Infected Aortic Grafts

Abstract Objective There is no international consensus regarding the optimum management of infected aortae (mycotic aneurysms, infected aortic grafts). Neoaortoiliac reconstruction has advantages over extra anatomical bypass grafting; however use of autologous vein is associated with venous hypertension and compartment syndrome, alternatively cadaveric homografts are associated with high rates of perianastomotic haemorrhage, limb occlusion and pseudoaneurysm. Arterial repair using xenoprosthetic patches is associated with lower infection rates compared to the use of prosthetic material. The aim of this case series and literature review is to report the use of xenoprosthetic bovine biomaterial for neoaortic repair of mycotic aneurysmal disease and infected aortic grafts. Methods Patients with evidence of infected aortic grafts or mycotic aneurysms who were suitable for open aortic surgery were included. Following removal of the graft / excision of the aneurysmal sac, a 10x16cm XenoSure Biological Surgical Patch (LeMaitre, Germany) was rolled into a tube, or bifurcated tube graft, and secured with prolene sutures. Proximal and distal anastomoses were conducted as per standard aortic anastomoses. Patients were continued on long-term antibiotics and surveyed with computerised tomography at 1, 3, 6 and 12 months. Results Six patients underwent bovine aortic repair between 2013-2015: an infected dacron aorto-biiliac graft causing iliac pseudoaneurysm, an infected dacron aortic graft from open repair later relined with endovascular stent graft, a mycotic iliac aneurysm, and 3 mycotic aortic aneurysms. All were treated with bovine reconstructed aortic grafts or patches. Patients had a median age of 69.5 years (range 67-75 years), with peri-operative and 30-day mortality of 0%. Median follow-up 13 months (range 2 – 23 months). Post-operative contrast enhanced-computed tomography revealed no evidence of infection at the operative site in all patients. Freedom from re-infection and re-intervention was 100%. Conclusions Xenoprosthetic (bovine) neoaortic grafts are an alternative method to treat infected aortae with excellent short term freedom from infection and reintervention. Optimum duration of post-operative antibiotic therapy remains undetermined. Further cases and longer follow up are required to determine the true efficacy of this technique.