Résumé
Objective: this study reports our local experience in situ reconstruction of native and prosthetic abdominal aorta infections, with an evolution of our practice from cryopreserved arterial allograft to bovine pericardial patch over the last 10 years. The aim of this study is to compare the results of these two substitutes in the short and medium term. Methods: this is a retrospective analysis performed at the university hospital of Montpellier from January 2010 to January 2020. The statistical analysis included 65 patients (mean age: 69 years; 59 men), who underwent in situ reconstruction for infections of aortic prostheses (n=48), endografts (n=13) and mycotic aneurysms (n=4) at the sub-renal stage. Thirty-eight patients were treated with cryopreserved arterial allografts (CAA) and 27 with bovine pericardium patches (PP). Patients were systematically reviewed with clinical and morphological evaluation at 3 months, then every year. Clinical, microbiological and CT scan pre and postoperative data were collected and analysed. Results: with a median follow-up of 13 months (0-116 months) in the CAA group and 18 months (0-40 months) in the PP group, the total reinfection rate is higher in the CAA group (31.6% vs 14.8% in the PP group) without significant difference. The reinfection rate is 0% at 1 month, 12% at 1 year and 27% at 3 years for PP (vs. 9%, 27%, 37% respectively for CAA), with 11% false aneurysms (n=3) and no aneurysmal degeneration. Total mortality is significantly higher in the CAA group (43.1% vs. 25.9% in the PP group) with a survival rate of 74% at 1 month, 55% at 1 year, and 45% at 3 years vs. 93%, 78%, 68% respectively in the PP group. The overall thrombosis rate is 13.2% in the CAA group versus 18.5% in the PP group with no significant difference between the two groups. Conclusion: given the severity of the disease and the patients comorbidities, in situ pericardial patch reconstruction appears to be a very promising option. It offers many advantages with not inferior results to those of CAA in terms of reinfection, survival and durability without degeneration. However, further studies with larger sample sizes are required.