Clinical Research|Articles in Press

Self-made bovine pericardial tube grafts for the treatment of abdominal aortic infections

Published:March 01, 2023DOI:



      Aortic infections are an uncommon but life-threatening disease. The material of choice for aortic reconstruction is still a matter of debate. The aim of this study is to examine the short and mid-term outcomes in the treatment of abdominal aortic infections using self-made bovine pericardium tube grafts.

      Material and methods

      This retrospective, single-center study collected all patients who underwent in situ abdominal aortic reconstruction using self-made bovine pericardial tube grafts between February 2020 and December 2021 in a tertiary care center. Patient comorbidities, symptoms, radiological, bacteriological and peri-operative findings, as well as postoperative outcomes were analyzed.


      Bovine pericardial aortic tube grafts were used in 11 patients (10 male, median age 68.7 years). Two patients presented a native aortic infection and nine had graft infections (four bypass grafts, four endografts and a plurioperated patient who had undergone both endovascular and open procedures). There were two emergent surgeries due to infectious aneurysm ruptures. All patients were symptomatic and the most frequent clinical finding was lumbar or abdominal pain (36%), followed by wound infection (27%) and fever (18%). Seven bifurcated and four straight pericardial tube grafts were needed. Purulent drainage was obtained around the previous graft or in the aneurysmal sac in 7 cases; intraoperative cultures were positive in 6 cases (Gram + bacteria). Two patients died in the immediate postoperative period (perioperative mortality 18%; urgent procedures 50%; scheduled procedures 11%). One patient had a major complication due to bilateral SARS-CoV2 pneumonia. There was one single reintervention to control hemostasis due to bleeding non-graft-related. The median follow-up was 14.1 months (3-24 months).


      Our preliminary experience in the treatment of abdominal aortic infections by in situ reconstrucción with self-made bovine pericardial tube grafts shows promising results. These should be confirmed in the long term.


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      7. References

        • Wilson WR
        • Bower TC
        • Creager MA
        • et al.
        Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association.
        Circulation. 2016; 134: 412-460
        • Berger P
        • Vaartjes I
        • Moll FL
        • De Borst GJ
        • et al.
        Cumulative incidence of graft infection after primary prosthetic aortic reconstruction in the endovascular era.
        Eur J Vasc Endovasc Surg. 2015; 49: 581e5
        • Lyons OT
        • Baguneid M
        • Barwick TD
        • et al.
        Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC).
        Eur J Vasc Endovasc Surg. 2016; 52: 758e763
        • Lyons OT
        • Patel AS
        • Saha P
        • et al.
        A 14- year experience with aortic endograft infection: management and results.
        Eur J Vasc Endovasc Surg. 2013; 46: 306e13
        • Kieffer E
        • Sabatier J
        • Plissonnier D
        • et al.
        Prosthetic graft infection after descending thoracic/thoracoabdominal aortic aneurysmectomy: management with in situ arterial allografts.
        J Vasc Surg. 2001; 33: 671-678
        • Heinola I
        • Sorelius K
        • Wyss T
        • et al.
        Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study.
        Journal American Heart Association. 2018; 7: 008-104
        • Weiss S
        • Tobler E
        • Tengg-Kobligk H
        • et al.
        Self-Made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections.
        Eur J Vasc Endovasc Surg. 2017; 54: 646-652
        • Anibueze C
        • Sankaran V
        • Sadat U
        • et al.
        Neoaortic Xenoprosthetic grafts for Treatment of Mycotic Aneurysms and Infected Aortic Grafts.
        Annals of Vascular Surgery. 2017;
        • Teebken OE
        • Bisdas T
        • Assadian O
        • Ricco J.-B
        Recommendations for Reporting Treatment of Aortic Graft Infections.
        Eur J Vasc Endovasc Surg. 2012; : 174-181
        • Batt M
        • Feugier P
        • Camou F
        • et al.
        A meta-analysis of outcomes after in situ reconstructions for aortic graft infection.
        Angiology. 2018; 69: 370-379
        • Hostalrich A
        • Ozdemir BA
        • Sfeir J
        • Solovei L
        • Alric P
        • Canaud L
        Systematic review of native and graft-related aortic infection outcome managed with orthotopic xenopericardial grafts.
        J Vasc Surg. 2019; 69: 614-618
        • Czerny M
        • Von Allmen R
        • Opfermann P
        • et al.
        Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures.
        Ann Thorac Surg. 2011; 92: 1657-1662
        • Kubota H
        • Endo H
        • Noma M
        • et al.
        Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta.
        J Cardiothorac Surg. 2015; 10: 133
        • Lutz B
        • Reeps C
        • Biro G
        • et al.
        Bovine pericardium as new technical option for in situ reconstruction of aortic graft infection.
        Ann Vasc Surg. 2017; 41: 118-126
        • Belkorissat RA
        • Sadoul C
        • Bouziane Z
        • et al.
        Tubular reconstruction with bovine pericardium xenografts to treat native aortic infections.
        Ann Vasc Surg. 2020; 64: 27-32
        • Alonso W
        • Ozdemir B
        • Chassin-Trubert L
        • et al.
        Early outcomes of native and graft-related abdominal aortic infection managed with orthotopic xenopericardial grafts.
        J Vasc Surg. 2021; 73: 222-231
        • Keschenau PR
        • Gombert A
        • Barbati ME
        • et al.
        Xenogenic materials for the surgical treatment of aortic infections.
        J Thorac Dis. 2021; 13: 5