Graft excision and extra-anatomic revascularization: the treatment of choice for the septic aortic prosthesis.
Graft excision and extra-anatomic revascularization is the treatment of choice for the septic aortic prosthesis. From 1979 to 1988, 20 patients underwent resection of aortic grafts and extra-anatomic bypass for the treatment of graft infections (No. 11) and aorto-enteric fistulas (No.9). The mean time interval from primary aortic surgery to the reoperative procedure was 65 months (range 1-192 months). Three patients died (one less than 30 days) after the secondary procedure for a mortality rate of 15%. One patient developed infection of the extra-anatomic bypass graft which resulted in an above-knee amputation. This was the only major limb loss in this series. A second patient developed contralateral buttock necrosis when he had unilateral axillary-femoral bypass without femoral-femoral bypass because of a previous above-knee amputation on the affected side. Major complications occurred in 7 patients (35%). Mean duration of follow-up after the reoperative aortic procedure was 44 months (range 6-120 months). One patient suffered aortic stump blowout 7 months after repair of an aortic duodenal fistula. Aortic graft excision and extra-anatomic revascularization of the lower extremities can be performed with low mortality and risk of limb loss and should remain the treatment of choice for aorto-enteric fistulas and infected aortic prostheses. Bilateral groin revascularization is important even in patients who have had a previous lower extremity amputation to provide pelvic blood flow.
Schmitt
D D
DD
Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee.
Seabrook
G R
GR
Bandyk
D F
DF
Towne
J B
JB
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery; D001424:Bacterial Infections / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors