A 10-year experience of using femoro-popliteal vein for re-vascularisation in graft and arterial infections.
BACKGROUND
Infected prosthetic grafts and mycotic aneurysms carry a high mortality and morbidity rate, with a substantial risk of persistent graft infection, but there is evidence that this can be minimised by using femoro-popliteal vein for arterial reconstruction after debridement and graft excision. We present our 10-year experience of this technique.


METHODS
Forty-six patients underwent 48 arterial reconstructions with femoro-popliteal vein (24 aortic). Six had mycotic aneurysms (three aortic) and 40 had graft infections (16 aortic).


RESULTS
There were two early postoperative deaths (4.3%) and two patients with pre-existing ischaemia underwent major amputation despite a patent graft. Median follow-up was 4.1 ears (range: 2 months to 10 years). Patient survival was 70% and limb salvage 96% at 5 years. Primary graft patency was 75% and 62% and secondary patency 93% and 91% at 2 and 5 years, respectively. Two patients required further surgery for recurrent infection. Anastomotic or graft stenosis occurred in 11 patients (24%). There were three major wound infections. Donor-limb swelling was transient.


CONCLUSIONS
For arterial and prosthetic graft infections, femoro-popliteal vein is an excellent conduit for vascular reconstruction after drainage and debridement of infected tissue and graft material under antibiotic cover, providing good long-term survival and limb salvage.
Department of Vascular Surgery, Morriston Hospital, Swansea, SW6 6NL, UK.
O
O
Ehsan
C P
CP
Gibbons
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017541:Aneurysm, False / Q000209:etiology; D000785:Aneurysm, Infected / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D003646:Debridement; D020878:Device Removal; D004322:Drainage; D004487:Edema / Q000209:etiology; D005260:Female; D005268:Femoral Vein / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein / Q000637:transplantation*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D000900:Anti-Bacterial Agents