Aortic versus non-aortic cryopreserved allograft and donor-specific outcome: a retrospective observational study

Introduction Cryopreserved arterial allografts are an established conduit for vascular reconstruction in patients with vascular graft infection (VGI). Although outcomes after aortic and peripheral implantation have been reported separately, comparative data including donor- and graft-specific characteristics are limited. This study compared clinical, procedural, and donor-related factors between aortic and non-aortic allograft implantation and evaluated their association with postoperative outcomes. Materials and methods This retrospective single-center study included all consecutive patients undergoing arterial allograft implantation between January 2023 and December 2025. Patients were stratified into aortic position (AP; n = 22) and non-aortic position (NAP; n = 29). Clinical, procedural, microbiological, donor-, and graft-specific variables were analyzed. Primary endpoints were in-hospital and 30-day mortality. Secondary endpoints included overall survival, primary graft patency, limb salvage and reintervention. Results Fifty-one patients received 112 cryopreserved arterial allografts in multisegment reconstructions. VGI was present in 76.5% of patients. Compared with NAP, AP reconstruction required longer operative time (343 vs. 262 min, p = .002) and greater blood loss (1,125 vs. 550 mL, p = .001). In-hospital/30-day mortality was higher after AP reconstruction (22.7% vs. 3.5%, p = .073), whereas primary graft patency and reintervention rates were comparable. Kaplan–Meier analysis demonstrated significantly reduced survival after aortic reconstruction (log-rank p = .011). Donor age, sex, graft storage duration, and transport characteristics were similar between groups. Non-aortic allografts showed significantly better histological quality ( p = .012). Discussion Aortic allograft reconstruction was associated with greater procedural complexity and reduced overall survival, likely reflecting the severity of underlying disease and extent of surgery. Histological graft quality differed significantly between implantation sites and may represent an underrecognized determinant of allograft outcomes. Conclusion Cryopreserved arterial allografts provide effective vascular reconstruction in both aortic and non-aortic positions, with favorable graft patency. Inferior survival after aortic reconstruction occurred despite largely comparable donor characteristics, aside from a higher histological quality grade in NAP. This finding is hypothesis-generating and warrants further evaluation. Prospective multicenter studies should determine whether histological graft assessment improves allograft selection and predicts long-term outcomes.