Complex aortofemoral prosthetic infections: the role of autogenous superficial femoropopliteal vein reconstruction.
BACKGROUND
With increasing experience, we have encountered patients with complex aortofemoral prosthetic infections in whom extra-anatomic bypass (EAB) is not an option.


OBJECTIVE
Autogenous superficial femoropopliteal vein (SFPV) aortic reconstruction provides a limb-saving and lifesaving alternative with acceptable morbidity and mortality.


METHODS
Retrospective review.


METHODS
University-based county, private, and Veterans Affairs hospitals.


METHODS
Seventeen patients with infected aortofemoral bypasses in whom conventional EAB was impossible because of infection of previously placed EAB, massive groin and/or thigh sepsis, or both.


METHODS
Morbidity and mortality.


RESULTS
Multiple previous operations were common (mean, 4 per patient) and included EAB (n = 11), replacement aortofemoral bypass (n = 4), prosthetic femoropopliteal bypass (n = 7), and thoracobifemoral bypass (n = 1); all bypasses became infected. Overall, 11 patients had sepsis at the time of presentation. Of the patients with massive groin infection, 7 had extensive deep infections involving most of the proximal thighs or retroperitoneum, 4 had enterocutaneous fistulae, and 2 had necrotizing fasciitis of the lower abdomen and thigh. Polymicrobial infections were common (n = 9). Four patients (24%) died in the perioperative period, 8 (47%) suffered major complications, and 4 (24%) underwent major amputations. Mortality in this group of patients was 3 times that of all other patients undergoing autogenous SFPV aortic reconstruction for prosthetic infection (8%). Amputation rates were also increased (24% vs 6%). The mean+/-SD follow-up time is 23+/-21 months. All patients maintained patent SFPV reconstructions.


CONCLUSIONS
In the setting of complex aortofemoral prosthetic infections, autogenous SFPV aortic reconstruction is a useful option for patients in whom EAB is impossible and limb loss and/or death would be inevitable without revascularization.
Gordon
L L
LL
Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9157, USA.
Hagino
R T
RT
Jackson
M R
MR
Modrall
J G
JG
Valentine
R J
RJ
Clagett
G P
GP
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D016459:Prosthesis-Related Infections; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods