Cor Vasa 2020, 62(5):466-469 | DOI: 10.33678/cor.2020.084

Aortic Reconstruction with Cryopreserved Human Allograft in a Hemodialysis Patient with Abdominal Aortic Aneurysm after Surgical Treatment of Liver Abscess

Ivan Kopolovets^a,c, Peter Berek^a, Vladimir Sihotsky^a, Jan Rosocha^b

^a Department of Vascular Surgery, Eastern Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic

^b Tissue Bank, Faculty of Medicine, P. J. Safarik University, Kosice, Slovak Republic

^c Uzhhorod National University, Research and Development Department, Uzhhorod, Ukraine

Background: Infection remains one of the major challenges facing vascular surgery, while patients with comorbidities have an increased risk of infectious complications irrespective of treatment approach. One of the challenges is abdominal aortic graft infection, when the radical treatment option is the removal of the infected material followed by in situ reconstruction, while the other one are patients with infection signs who require primary aortic reconstruction without postponing surgery. Case presentation: We present a case of effective surgical treatment of abdominal aortic aneurysm in a polymorbid 78-year-old woman with chronic kidney failure. Computer tomography revealed an abscess in the left hepatic lobe and a 10 × 7 cm abdominal aortic aneurysm with no evidence of perforation. The liver abscess was drained by surgeons. 14 days after the surgery the patient was still complaining about abdominal pain radiating to lumbar region, so it was referred to a vascular surgeon. CT angiography revealed progression of abdominal aortic aneurysm (10 cm × 7.5 cm) with no apparent extravasation. Furthermore, significant regression of liver abscess size and a formed collection (seroma) or an abscess pocket on the ventral surface of the left liver lobe were found. Considering the following factors: progression of abdominal aortic aneurysm size with perforation risk, the 14th day after evacuating left lobe liver abscess, confirmed seroma or abscess pocket on the ventral surface of the left liver lobe, clinical manifestations of bacterial infection (CRP - 78 mg/l), stage 5 chronic kidney failure, it was decided that an aortic reconstruction was to be performed with cryopreserved human allograft. The postoperative period was uneventful, and the patient with no signs of early postoperative complications was discharged on the 15th day.

Conclusion: The cryopreserved human allograft is the treatment of choice for both aortic graft infection and primary aortic reconstruction in patients at high risk of graft infection after surgery.

Keywords: Cryopreservation, Infection, Vascular allotransplantation, Xenograft

Received: May 27, 2020; Revised: September 15, 2020; Accepted: September 15, 2020; Published: November 1, 2020  Show citation