Partial infection of the aorto-uni(bi)femoral graft partial conservation and replacement with autologous material. Is it a reality?
The infection of the aorto-uni(bi)femoral graft is a serious complication, associated with high morbidity and mortality rates - severe implications on the vital prognosis (haemorrhage, sepsis) or of the peripheral vascularisation. Frequently, the infections of aorto-uni (bi) femoral grafts first appear at the level of the distal anastomosis, in Scarpa's triangle.


METHODS
We are going to discuss a number of 6 cases of localised unilateral infection, situated in Scarpa's triangle. The infections appeared either during the first 3 months after the initial implantation of the graft, or later on (2 cases), after 2 and 5 years, respectively. The cases span over a period of 10 years covering a total number of 226 patients with aorto-uni(bi)lateral grafts. Our treatment of choice was to use autologous material, namely the superficial femoral vein, as replacement for the partially infected graft, which was harvested and placed in the iliac position during the same procedure. The surgical intervention was divided into an aseptic time, which involved harvesting the autologous conduit (superficial femoral vein), the proximal anastomosis between the non-contaminated portion of the graft and the venous graft, followed by closure; next, there was a septic time, that included entering the infected wound, extracting the contaminated segment of the graft and distal anastomosis between the femoral vein graft and the receptive artery. In five of the cases the venous conduit was passed through the same anatomical space from where the graft was extracted; in one case it was passed through the obturator channel and anastomosed to the superficial femoral artery at a lower level. The patients received pre- and postoperative intravenous antibiotics in accordance to the cultures taken from the infected wound, up to a period of 2-3 weeks, followed by another 3 weeks of oral antibiotics after discharge.


RESULTS
All the patients survived the intervention. Postoperatively oedema of the lower leg and thigh was observed in all of the patients, similar to that appearing in deep venous thrombosis, and required treatment with low molecular weight heparin and long term oral anticoagulation with antivitamin K products.Patients were monitored postoperatively at intervals of one, three and six months followed by two annual check-ups. Biological tests and colour Duplex scans showed no signs of recurrent infection.


CONCLUSIONS
Localized partial graft infections are a reality, confirmed by clinical, biological, ultrasound examinations, intra-operative explorations and postoperative results achieved by selective surgical resection. Infectious reoccurrence was not observed during the period of study.
Popa
R F
RF
Department of Vascular Surgery, Gr.T. Popa University of Medicine and Pharmacy Iaşi.
Popa
Cristina
C
Grigoraş
Ioana
I
Zaib
Khawaja
K
Raza
Ahmad
A
Baroi
Genoveva
G
Aursulesei
Viviana
V
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005268:Femoral Vein / Q000637:transplantation*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007866:Leg / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013848:Thigh / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin