Experience with femoro-popliteal vein as a conduit for vascular reconstruction in infected fields.
OBJECTIVE
to review the outcome of femoro-popliteal vein grafts for arterial reconstruction in the presence of sepsis.


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.


CONCLUSIONS
femoro-popliteal vein reconstruction with debridement and appropriate antibiotic therapy is recommended for the treatment of arterial or graft infections.
Gibbons
C P
CP
Department of Vascular Surgery, Morriston Hospital, Swansea SA6 6NL, UK.
Ferguson
C J
CJ
Fligelstone
L J
LJ
Edwards
K
K
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D003646:Debridement; D005260:Female; D005268:Femoral Vein / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000601:surgery*; D011152:Popliteal Vein / Q000637:transplantation*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D014654:Vascular Patency
D000900:Anti-Bacterial Agents