title: The efficacy of autologous femoropopliteal vein reconstruction for primary aortic and aortic graft infection.
abstract: BACKGROUND
  The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection.
  
  
  METHODS
  We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected aorta between 2012 and 2014. Three patients had a primary mycotic aneurysm caused by a Salmonella or Coxiella burnetti infection. Seven patients were treated previously for aortic aneurysms with a conventional Dacron vascular prosthesis and 4 with an endovascular prosthesis. All infected prostheses were explanted via median laparotomy with subsequent debridement of the aortic aneurysm wall. Aortic reconstruction was performed with 1 or 2 superficial femoropopliteal veins, interpositioning the greater omentum when possible. The primary outcome measure was 30-day mortality. Secondary outcome measures were reoperation, operating time, amputation rate, length of intensive care unit (ICU) and hospital stay, reinfection rate, and limb edema requiring compression therapy.
  
  
  RESULTS
  The 30-day mortality was 28%. Two patients died of an abdominal sepsis, one patient of a cerebrovascular accident and another of a hypovolemic shock. One patient died at home 2 years after surgery of unknown cause. Four patients required a reoperation. The median intraoperative blood loss was 1,500 mL (500-8000). Median operating time was 364 min (264-524). Median length of ICU stay was 3.5 days (1-47), and median hospital stay was 20 days (10-47). There were no limb amputations. Mild edema of the donor leg was documented in 2 patients. Compression stockings were not worn by any patients. Postoperative antibiotic treatment was administered for at least 6 weeks. No recurrent infections were diagnosed.
  
  
  CONCLUSIONS
  Autologous venous reconstruction of the aorta offers advantages over other therapeutic approaches and deserves a prominent place in the treatment of the primary infected aorta or an infected aortic prosthetic graft.
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Vascular Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. Electronic address: mark.dirven@mumc.nl.
authors.forename: Mark
authors.initials: M
authors.lastname: Dirven
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michel F
authors.initials: MF
authors.lastname: van der Jagt
authors.affiliation: Department of Vascular Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Wout B
authors.initials: WB
authors.lastname: Barendregt
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: van der Vliet
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D064592:Autografts; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein / Q000637:transplantation*; D049268:Positron-Emission Tomography; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D011778:Q Fever / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012480:Salmonella Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents