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Castronovo EL, Bissacco D, Trimarchi S, Mezzetti R. Neoaortoiliac system in treating aortic graft infections: a single center long-term experience and review of the literature. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:160-168. [PMID: 35142460 DOI: 10.23736/s0021-9509.22.12063-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Aortic graft infection represents one of the most challenging and life-threatening complication of surgical and endovascular treatment of aortic pathologies. The aim of this study was to report the results of a single center with in-situ revascularization for the treatment of aortic graft infections using the neo-aorto-iliac system (NAIS) and to review the literature about this surgical technique. METHODS We retrospectively reviewed our aortic graft infection case series and in-situ revascularization using the neo-aorto-iliac system. The study was conducted from January 2009 to June 2020. The primary outcomes analyzed were early mortality (<30 days), late mortality (>30 days), reinfection rate. Secondary outcomes were the primary patency rate, the secondary patency rate, and the lower limb salvage rate. A literature review of the last twenty years was performed on international medical databases Pubmed (Medline), Scopus and Web of Science. RESULTS During study period, 12 patients, all male (median age of 69 years [range: 52-87 years]), underwent to infected graft explantation and revascularization by NAIS using femoral-popliteal veins. Six cases were complicated by aorto-enteric fistulas, five were duodenal and one was colon. Patients spent the immediate postoperative period in the Intensive Care Unit for a median time of 4 days (range: 0-9 days). The median length of hospital stay was 27.5 days (range: 1-66 days). The mean follow-up was 21.5 months (range: 0-120). The 30-day mortality rate was 25% (3 patients) due to postoperative complications. No patient dropped out of the follow-up protocol. The primary patency rate was 92% while the secondary patency rate was 100%. No patient underwent lower limb amputation. Persistence of infection occurred in 1 case (8.3%). Overall Kaplan-Meier survival estimates were 75% for 30 days, 50% for 1 year, 48% for 5 years. Literature analysis identified 19 case series. CONCLUSIONS The literature regarding NAIS has low statistical evidence due to retrospective design of the studies. Our results are in agreement with retrospective studies in the literature. When the surgical team is confident with NAIS, this technique should be considered the preferred method, considering an acceptable and comparable mortality rate with other techniques and a better rate of patency, resistance to graft degeneration, recurrent infections and amputation rate.
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Affiliation(s)
- Enza L Castronovo
- Unit of Vascular Surgery, San Marco Polyclinic, Zingonia, Bergamo, Italy -
| | - Daniele Bissacco
- Unit of Vascular Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Mezzetti
- Unit of Vascular Surgery, San Marco Polyclinic, Zingonia, Bergamo, Italy
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Eilenberg W, Klopf J, Domenig CM, Klinger M, Wolf F, Gollackner B, Nanobachvili J, Neumayer C. The Femoral Vein as a Long-Term Aorto-Iliac Graft for Aortic Infection and Aortitis. World J Surg 2022; 46:1235-1242. [PMID: 35118519 PMCID: PMC8971159 DOI: 10.1007/s00268-022-06460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
Background Reconstruction of the aorto-iliac segment with femoral vein (FV) as substitute for infected synthetic grafts or mycotic aneurysms constitutes the most sustainably convenient alternative. The aim of this study was to evaluate the long-term outcome of up to 16 years of follow-up, analysing the morphologic adaption of the FV with special emphasis on the distal and proximal anastomoses. Methods We conducted a retrospective study of 22 patients with 109 computed tomography angiograms (CTAs) treated between August 2001 and January 2020 in case of aortic infection/aortitis. Morphologic changes like anastomotic dilatation/stenosis as well as changes of FV wall thickness were retrospectively analysed in pre- and postoperative CTAs. Results Elective procedure was done in 17/22 (77%) cases, and 5/22 (23%) patients required emergent surgery. The median follow-up was 91.5 months (P25;P75 = 21;117). Cross-sectional diameter of proximal (20.38 ± 3.77 vs 22.04 ± 3.97 mm, p = 0.007) and distal anastomoses (13.05 ± 4.23 vs 14.61 ± 5.19 mm, p = 0.05) increased significantly, as well as the proximal and distal anastomotic areas (3.36 ± 1.29 vs 4.32 ± 1.63 mm2, p = 0.04 and 0.99 ± 0.48 vs 1.25 ± 0.72 mm2, p = 0.023, respectively). Venous wall thickness was significantly reduced at the anastomotic site (1.74 ± 0.46 vs 1.24 ± 0.31 mm, p = 0.001). The upper thigh diameter did not differ before and after harvesting of the FV (161.6 ± 29.1 vs. 178.2 ± 23.3 mm, p = 0.326, respectively). Conclusion This long-term CTA follow-up study showed that the FV wall becomes thinner at the anastomotic site, and the anastomoses dilate with time without rupture. The FV is a durable conductor after replacement of the aorto-iliac segment due to aortic infection. Further CTA studies from more centres are warranted to evaluate the risk of vein rupture.
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Affiliation(s)
- W Eilenberg
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Klopf
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - C M Domenig
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Klinger
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - F Wolf
- Department of Biomedical Imaging and Image Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - B Gollackner
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Nanobachvili
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - C Neumayer
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Aortobisiliac Bypass Using a Venous Homograft Concomitant With Kidney Transplantation in a Patient With Severe Bilateral Iliac Occlusive Disease: A Case Report. Transplant Proc 2019; 51:226-228. [PMID: 30612706 DOI: 10.1016/j.transproceed.2018.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 06/21/2018] [Indexed: 11/20/2022]
Abstract
Aortoiliac occlusive disease (AOD) is a great threat for kidney transplantation (KT). Here we report the case of an aortoiliac bypass, performed simultaneously with renal transplantation using venous grafts obtained from the deceased donor. The recipient was a 68-year-old woman with significant stenosis of the aortoiliac axis. We performed an aortobisiliac bypass using donor's femoral veins because presence of methicillin-resistant Staphylococcus aureus was detected on donor hemoculture and contraindicated a prosthetic implant on the recipient. KT was then carried out using standard technique. Operative time amounted to 330 minutes and cold ischemia time of the renal graft was 900 minutes. Delayed graft function was observed until postoperative day 12, but the patient showed a good urine output and a serum creatinine of 2.1 mg/dL at discharge. AOD is not an absolute contraindication to renal transplantation, and simultaneous surgical repair of aortoiliac lesions with KT seems feasible. The patient's return to function after initial delayed graft function suggests that such interventions may allow transplantation to be offered to those patients who otherwise may be excluded for severe vascular comorbidities. Homologous vascular grafts are an excellent choice because prosthetic vascular replacement during immunosuppression must be avoided as long as possible, especially in patients with coexisting infective risk.
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Abstract
A 78-year-old male presented with early gastric cancer and a 5.5 cm-sized infrarenal abdominal aortic aneurysm, detected during regular screening. Endovascular aneurysm repair (EVAR) was performed first, followed by laparoscopic distal gastrectomy. After gastrectomy, the patient underwent computed tomography (CT) scan due to persistent fever, which showed increased perigraft fluid collection around the right iliac limb graft. Echocardiography also revealed mitral valve vegetation, consistent with infective endocarditis. Despite intensive antibiotic treatment, the patient had persistent fever and showed fluid extension to the psoas muscle on CT scan. On the 49th post operative day (POD) after EVAR, stent graft explantation and aortic reconstruction with the left superficial femoral vein was performed. Ligation of the right iliac artery for infection control and simultaneous femoro-femoral bypass was also performed. The patient was discharged on the 46th POD after graft removal without any events
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Affiliation(s)
- Hong Kyung Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Young Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Tsiplakou S, Voulalas G, Kiliari E, Kastrisios G, Maltezos C. Post-operative wound and vascular graft infection caused by Haemophilus parainfluenzae. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Elena Kiliari
- Microbiology Laboratory, KAT Hospital, Athens, Greece
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Mussa FF, Hedayati N, Zhou W, El-Sayed HF, Kougias P, Darouiche RO, Lin PH. Prevention and treatment of aortic graft infection. Expert Rev Anti Infect Ther 2014; 5:305-15. [PMID: 17402845 DOI: 10.1586/14787210.5.2.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prosthetic vascular graft infection remains one of the most challenging surgical problems for vascular surgeons. This condition is classically associated with high morbidity and mortality rates. Accurate diagnosis of a vascular graft infection can typically be made based on a thorough history and physical examination; although, infrequently, an extensive radiological evaluation is necessary to establish the clinical finding. Complete graft excision and extra-anatomic bypass grafting remains a commonly accepted surgical treatment strategy. Recent clinical data have supported other treatment modalities, including the use of in situ antibiotic-impregnated graft replacement, in situ allograft replacement and in situ autologous graft replacement. This article will review the pathobiology of aortic graft infection, as well as methods to prevent a prosthetic graft infection. Furthermore, various surgical treatment modalities of aortic graft infection will be discussed.
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Affiliation(s)
- Firas F Mussa
- The Michael E DeBakey VA Medical Center, Division of Vascular Surgery & Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Grass F, Deglise S, Corpataux JM, Saucy F. In situ aortobiiliac reconstruction of infected aneurysm using a single superficial femoral vein. Vasc Endovascular Surg 2013; 47:390-3. [PMID: 23651698 DOI: 10.1177/1538574413487263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate successful in situ aortoiliac reconstruction of an infected infrarenal aneurysm using one single superficial femoral vein (SFV). METHODS In situ reconstruction using the right SFV sutured in end-to-end anastomosis with the aorta and distally with the right common iliac artery and in end-to-side anastomosis with the left common iliac artery. RESULTS The operating time was less than reported for aortic in situ reconstruction with bilateral SFV harvesting. The duplex scan 3 months postoperatively showed permeability of the bypass without any anastomotic stenosis or pseudoaneurysm. The right common femoral, popliteal, and greater saphenous veins were patent without thrombus, and the patient did not complain about peripheral edema. CONCLUSIONS The use of only one instead of both the SFVs for aortobiiliac in situ reconstruction might be a way to reduce operating time and allow autogenous venous reconstruction even in patients with limited availability of venous material.
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Affiliation(s)
- Fabian Grass
- Department of Vascular and Thoracic Surgery, University Hospital CHUV, Lausanne, Switzerland.
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Kaczynski J, Atherton S, Davies CG, Ferguson CJ. Reconstruction with the use of autologous femoropopliteal veins for an infected aortobifemoral bypass graft. BMJ Case Rep 2013; 2013:bcr-2013-008586. [PMID: 23429026 DOI: 10.1136/bcr-2013-008586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jakub Kaczynski
- Vascular Surgery Department, ABM University Health Board, Swansea, UK.
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Ghosh J, Bhowmick A, Baguneid M. Oncovascular surgery. Eur J Surg Oncol 2011; 37:1017-24. [PMID: 21917411 DOI: 10.1016/j.ejso.2011.08.131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/11/2011] [Accepted: 08/22/2011] [Indexed: 01/31/2023] Open
Affiliation(s)
- J Ghosh
- Department of Vascular Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Greater Manchester, UK.
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Ghosh J, Naik J, Chandrasekar C, Yin Q, Vallabhaneni SR. Use of a superficial femoral artery autograft as a femoral vein replacement during en bloc sarcoma resection. Vasc Endovascular Surg 2011; 45:665-7. [PMID: 21821637 DOI: 10.1177/1538574411407697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Soft tissue malignancy encasing axial vessels presents a surgical challenge when the goal is limb-preserving radical excision. REPORT We describe a case where limb-preserving resection of a myxoid liposarcoma involving the femoral vessels was successfully performed in the absence of autologous superficial vein for vascular reconstruction. The proximal ipsilateral superficial femoral artery was harvested as an autograft for venous reconstruction, with the arterial defect bridged using a polytetrafluoroethylene interposition graft. DISCUSSION This technique may be selectively extended to other indications where limb viability is dependent upon availability of a high-quality graft, and conventional conduits are either unavailable or unreliable.
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Affiliation(s)
- Jonathan Ghosh
- Department of Vascular & Endovascular Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
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11
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Ehsan O, Gibbons C. A 10-year Experience of Using Femoro-popliteal Vein for Re-vascularisation in Graft and Arterial Infections. Eur J Vasc Endovasc Surg 2009; 38:172-9. [DOI: 10.1016/j.ejvs.2009.03.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 03/16/2009] [Indexed: 11/25/2022]
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Simms M, Mehat MS, Buckels JAC. The use of autologous femoral vein for the repair of the common iliac vein after resection of a pheochromocytoma. Phlebology 2008; 23:227-9. [DOI: 10.1258/phleb.2008.007081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aim To illustrate the use of autologous femoral vein for grafting ilio-caval vein defects following abdomino-pelvic tumour resections. Methods Case report and literature review. Results Durable restoration of ilio-caval patency was achieved, with minimal morbidity from graft harvesting. Conclusions Autologous femoral vein presents a viable graft option for the immediate reconstruction of large intra-abdominal vein deficits.
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Affiliation(s)
- M Simms
- Department of Vascular Surgery
| | | | - J A C Buckels
- Department of Hepato-biliary-pancreatic Surgery and Liver Transplant Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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13
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Neoaortoiliac reconstructions using femoropopliteal veins: MDCT angiography findings. AJR Am J Roentgenol 2008; 191:569-77. [PMID: 18647934 DOI: 10.2214/ajr.07.3444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this article, we discuss the neoaortoiliac system procedure, a surgical procedure that uses femoropopliteal vein segments for arterial reconstructions in patients with aortofemoral prosthetic graft infections. CONCLUSION CT angiography (CTA) is a powerful imaging tool that can be used in the follow-up of patients after this complex surgery. CTA accurately detects early and late complications that may develop after the neoaortoiliac system procedure.
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McKay A, Motamedi M, Temple W, Mack L, Moore R. Vascular reconstruction with the superficial femoral vein following major oncologic resection. J Surg Oncol 2007; 96:151-9. [PMID: 17443742 DOI: 10.1002/jso.20788] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Involvement of critical vascular structures has historically been considered a contraindication to tumor resection. This study describes outcomes following radical oncologic resection with concomitant resection of critical vascular structures and reconstruction with the superficial femoral vein (SFV). METHODS All patients undergoing radical oncologic resection requiring resection of major vascular structures and concomitant reconstruction using the SFV as conduit were retrospectively reviewed. Primary outcomes were surgical morbidity and mortality; secondary measures included long-term patency and oncologic outcomes. RESULTS Seven patients were included. There were three retroperitoneal and two groin sarcomas, and two squamous cell carcinomas metastatic to groin lymph nodes. No perioperative mortality occurred. Five patients experienced minor morbidity. One vein graft in a patient with pre-existing chronic deep venous thrombosis (DVT) occluded post-operatively. No subsequent long-term venous or arterial graft occlusions occurred (median 20.2 months, range 9.0-49.7). Two patients died of tumor recurrence during follow-up. CONCLUSIONS Resection of tumors involving critical vascular structures is feasible. The SFV conduit is a versatile option for major vascular reconstruction, providing good long-term patency rates with acceptable morbidity and mortality. Vascular resection and reconstruction with the SFV offers another technique to provide limb-sparing surgery in patients traditionally offered only amputation, while providing favorable oncologic outcomes.
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Affiliation(s)
- Andrew McKay
- Department of Surgery, Division of Surgical Oncology, University of Calgary, Calgary, Alberta, Canada.
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Rawat N, Lock D, Gibbons CP. Pancreatic Abscess Involving the Aortic Graft Following Repair of a Ruptured Aortic Aneurysm: Successful Replacement with Femoro-popliteal Vein. Eur J Vasc Endovasc Surg 2006; 32:146-8. [PMID: 16520068 DOI: 10.1016/j.ejvs.2006.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 01/10/2006] [Indexed: 11/19/2022]
Abstract
Acute pancreatitis is a rare complication after aortic surgery and carries a high mortality. We report the successful management of an infected aortic graft secondary to complicated severe pancreatitis in a 77-year-old man by open drainage of the abscess and replacement of the prosthetic graft with superficial femoro-popliteal vein (SFPV). The patient remains free from infection with a patent graft 8 months later.
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Affiliation(s)
- N Rawat
- Department of Vascular Surgery, Morriston Hospital, Swansea, UK
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Reid JDS, MacDonald PS. Removing the Infected Aortofemoral Graft Using a Two-Stage Procedure with a Delay Between the Stages. Ann Vasc Surg 2005; 19:862-7. [PMID: 16200471 DOI: 10.1007/s10016-005-7759-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study describes the results of a procedure for removing the infected aortofemoral graft using a two-stage procedure with a delay between the stages. The objective was to lessen the morbidity and mortality associated with removing an infected graft through a single operation. Eight consecutive patients were treated in this manner over a 6-year span. The indications for surgery were infected groin false aneurysms in three, chronic draining sinuses involving the prosthetic graft in four, and an open groin infection involving graft in one. There were five males and three females, with ages ranging 47-83 years (mean = 63). The mean operative time of the first-stage operation was 5.1 hr (range 3.0-7.7), and the mean blood transfusion requirement was 1.7 units. The mean operative time of the second stage operation was 3.5 hr (range 3.5-7.6), and the mean blood transfusion requirement was 2.5 units. In six patients, the hospital course was uncomplicated, with a mean hospital stay of 8.4 days for the initial stage and 9.2 days for the second stage. Two patients had complicated postoperative courses with hospital stays of >30 days. There was no operative or graft-related late mortality. No patients were lost to follow-up. One patient died of unrelated causes with a patent graft at 22 months postsurgery. All other patients remain well with patent grafts, without requiring revisions at a mean follow-up of 33 months (range 6-73). A two-stage approach with a delay between the stages may reduce the morbidity and mortality associated with the removal of an infected aortobifemoral graft.
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Affiliation(s)
- John D S Reid
- Division of Vascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Hughes R, Moawad M, Harvey JS, Von Oppell U, Byrne J. Thoracofemoral bypass using spliced femoral vein with removal of an infected axillobifemoral bypass graft. Eur J Vasc Endovasc Surg 2005; 29:429-32. [PMID: 15749045 DOI: 10.1016/j.ejvs.2004.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 12/22/2004] [Indexed: 11/26/2022]
Abstract
A 63-year-old male underwent emergency repair of a ruptured juxtarenal aortic aneurysm via a transabdominal approach using an aorto-bi-iliac Dacron graft. This became infected. A right axillobifemoral bypass was placed and the infected graft was removed with oversewing of the aorta. The patient was re-admitted 8 months later with an infected axillobifemoral prosthesis. We harvested both femoral veins (FV) and spliced them to perform a left thoracobifemoral bypass with simultaneous explantation of the infected graft. The patient remains well with a patent graft 20 months post-operatively.
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Affiliation(s)
- R Hughes
- Cardiff Vascular Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
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18
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Gibbons CP, Ferguson CJ, Fligelstone LJ, Edwards K. Experience with femoro-popliteal vein as a conduit for vascular reconstruction in infected fields. Eur J Vasc Endovasc Surg 2003; 25:424-31. [PMID: 12713781 DOI: 10.1053/ejvs.2002.1853] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to review the outcome of femoro-popliteal vein grafts for arterial reconstruction in the presence of sepsis. PATIENTS AND METHODS twenty-six patients underwent 27 arterial reconstructions with femoro-popliteal vein in the presence of infection. Five had mycotic aneurysms (3 aortic, 1 iliac and 1 femoral), 21 had prosthetic graft infections (9 aortic, 8 femoro-femoral, 2 axillo-femoral, 1 ilio-femoral and 1 femoral dacron patch) and one underwent superior mesenteric artery reconstruction following ischaemic small bowel perforation.Arterial reconstruction followed debridement of infected tissue, removing any infected graft, povidone iodine washout and appropriate antibiotic cover. Where possible, new grafts were placed in a clean field or wrapped in omentum. Four femoral anastomoses were covered by rectus femoris flaps. RESULTS there was one early postoperative death (4%) and no limb loss. All others remained free from infection with patent grafts at 1 month to 5 years (median 22 months). Three major wound infections healed without exposing the graft. One infarcted rectus femoris flap required removal. Donor limb swelling was transient. Five required percutaneous angioplasty and one underwent open profundaplasty within 3 months. CONCLUSION femoro-popliteal vein reconstruction with debridement and appropriate antibiotic therapy is recommended for the treatment of arterial or graft infections.
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Affiliation(s)
- C P Gibbons
- Department of Vascular Surgery, Morriston Hospital, Swansea SA6 6NL, UK
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Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg 2003; 25:240-5. [PMID: 12623336 DOI: 10.1053/ejvs.2002.1835] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins. METHODS forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied. Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan. The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins. After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan. RESULTS there were four in-hospital deaths (8%). One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%). With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%). There were no late amputations and only two late graft limb stenoses (4%). We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91%. There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection. CONCLUSION in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.
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Affiliation(s)
- K Daenens
- Center for Vascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium
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Gibbons CP. Venous reconstruction. Eur J Vasc Endovasc Surg 2002; 23:569; author reply 569-70. [PMID: 12146455 DOI: 10.1053/ejvs.2002.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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