Axillary-popliteal artery bypass provides successful limb salvage after removal of infected aortofemoral grafts.
Axillary-popliteal artery bypasses were placed to revascularize 28 extremities for 17 patients who were undergoing removal of infected aortofemoral grafts. Polytetrafluoroethylene (PTFE [polytef]) material was anastomosed to the above-knee popliteal artery in 22 cases and to the below-knee popliteal artery in six limbs. All but one patient had axillary-popliteal grafts in place before excision of the aortic graft. In 12 groins, vein-patch angioplasty was performed after removal of the infected aortic graft to provide retrograde pelvic perfusion and maintain femoral patency for future reconstruction. Three patients (18%) died of septic-related, multisystem organ failure. With a mean follow-up of 25 months, primary patency was 75% at 1 year and 43% at 2 years. Secondary patency, maintained by thrombectomy (n = 7), revision (n = 3), and conversion to warfarin sodium (Coumadin) therapy (n = 6) was 100% at 2 years, and limb salvage was achieved for all surviving patients.
McCarthy
W J
WJ
Department of Surgery, Northwestern University Medical School, Chicago, Ill.
McGee
G S
GS
Lin
W W
WW
Pearce
W H
WH
Flinn
W R
WR
Yao
J S
JS
D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery; D001019:Aortic Rupture / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery*; D001424:Bacterial Infections / Q000209:etiology*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011150:Popliteal Artery / Q000601:surgery*; D012086:Reoperation; D016879:Salvage Therapy; D014654:Vascular Patency
D011138:Polytetrafluoroethylene