Ten-Year Experience Using Cryopreserved Arterial Allografts for Vascular Reconstruction during Major Oncologic Surgery.

Abstract

Objective: Resection of vascular-encasing tumors has been associated with high morbidity and mortality. However, advances in surgical techniques and cancer treatments have improved outcomes for patients undergoing resection with vascular reconstruction. In specialized centers, cryopreserved arterial allografts (CAAs) are increasingly used when autologous conduits are unavailable, offering superior anatomical compliance and resistance to infection compared to prosthetic conduits. This study aimed to evaluate the outcomes of CAAs as a conduit for vascular reconstruction during major oncological surgery.

Methods: A retrospective review was conducted on patients without suitable autologous conduits who underwent tumor-related vascular reconstruction with CAAs between January 2014 and May 2024. Outcomes evaluated included conduit patency, freedom from CAA-related reintervention, CAA-related complications, and overall survival.

Results: A total of 44 patients (mean age 57 ± 14 years; 61% female) underwent vascular reconstruction using commercially available femoral and aortoiliac CAAs during resection of abdominopelvic, peripheral, and neck tumors. Pancreatic ductal adenocarcinoma was the most common tumor type (73%, n=32). Single-vessel reconstruction was required in 27% of patients (n=12), while multivessel reconstruction was required in 73% (n=32). Ninety-three vessels were reconstructed, with a technical success rate of 100%. At 24 months, primary patency was 65% and 46% (p=0.19), primary-assisted patency was 75% and 68% (p=0.73), and secondary patency was 80% and 78% (p=0.95) for arterial and venous reconstructions, respectively. Freedom from CAA-related reintervention was 60%. Hemodynamically significant stenosis (>50% luminal narrowing) was observed in 57% (n=25) of patients; of these, 23% (n=10) progressed to occlusion. An additional 11% (n=5) experienced occlusion without prior stenosis. Structural CAA defects included pseudoaneurysm in 16% (n=7) of patients, all after pancreatic resection. Fistula formation in 4% (n=2), and anastomotic dehiscence in 2% (n=1) of patients. The 36-month survival rate was 50% for patients with non-pancreatic tumors and 23% for those with pancreatic tumors.

Conclusions: CAAs are a technically feasible alternative for tumor-related vascular reconstruction, offering acceptable patency rates and freedom from reintervention. They provide a valuable conduit option in clean-contaminated fields and when autologous conduits are unavailable. However, the risk of pseudoaneurysm mandates diligent surveillance in specific settings.