Perioperative and Mid-term Outcome of Prefabricated Bovine Pericardial Grafts in the Context of Infected Aortic/Iliac Pathologies.

BACKGROUND

Native or graft-associated aortoiliac infections are rare but associated with a high morbidity and mortality. Prefabricated straight or bifurcated bovine pericardial grafts are among the available open surgical reconstruction options. To date, only few data on the short- and midterm outcomes have been published. The aim of the present study was to analyze the outcomes of surgery in infected aortic, aortoiliac, and iliac pathologies at our center using prefabricated bovine pericardial grafts.

METHODS

Retrospective, single-center outcome analysis of all consecutive patients who underwent open surgical repair between 2020 and 2023 with a factory-presewn bovine pericardial graft for aortic, aortoiliac, and iliac infectious disease at a university-affiliated tertiary care hospital. Primary outcome were bovine pericardial graft-associated morbidity and mortality.

RESULTS

During the study period, 26 patients underwent 27 open surgical aortic, aortoiliac, or iliac reconstructions using a straight or bifurcated BioModiVasc® Perima™ (BioModiVasc Inc., Mississauga, Ontario, Canada) bovine pericardial graft due to an infective native aortic aneurysm, vascular graft or endograft infection, trauma with contamination, acute Leriche syndrome with adjacent infection, or recurrence of soft tissue sarcoma excision. Risk factors for vascular infections, mainly recent vascular procedure and recent infection at a remote site, were detected in n = 18 (66.7%) patients. Technical success, defined as complete graft removal (in graft infections), extensive débridement, successful vessel reconstruction, and no bovine pericardial graft-related early (30-day) mortality, was achieved in n = 24 (88.9%) cases. Median follow-up was 18 months (11-25, IQR 14). Thirty-day mortality was n = 4 (14.8%), due to sepsis or cardiac events. At 1 year, primary and assisted primary patency rates were 85.2% and 96.3%, respectively.

CONCLUSION

Prefabricated bovine pericardial grafts are a viable option in the treatment of infectious aortoiliac pathologies. Apart from favorable midterm results, their off-the-shelf availability, the lack of harvesting morbidity, and the potential sparing of operating time are main advantages.