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Eidt JF, Parrott ME, Gucwa AL, B Chu TH, Bettacchi C, Mb Musser J. The Role of Feral Swine in Human Aortic Infection With Brucella Species. Vasc Endovascular Surg 2023; 57:941-948. [PMID: 37313853 DOI: 10.1177/15385744231183786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products.
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Affiliation(s)
- John F Eidt
- Baylor Scott and White Heart and Vascular Hospital, Texas A&M Health Science University, Dallas, TX, USA
| | - Megan E Parrott
- General Surgery Residency Program, Baylor University Medical Center, Dallas, TX, USA
| | - Angela L Gucwa
- Doctors Community Medical Center, Luminis Health, Annapolis, MD, USA
| | - Tuan-Hung B Chu
- Baylor Scott and White Heart and Vascular Hospital, Texas A&M Health Science University, Dallas, TX, USA
| | - Chris Bettacchi
- North Texas Infectious Disease Consultants, Division of Infectious Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Jeffrey Mb Musser
- Department of Veterinary Pathobiology, Texas A&M University College of Veterinary Medicine, College Station TX, USA
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Eidt JF, Gucwa AL, Ali A. How I do it: The neoaortoiliac system for treatment of aortoduodenal fistula after endovascular aortic repair. J Vasc Surg Cases Innov Tech 2022; 8:830-839. [PMID: 36561355 PMCID: PMC9763360 DOI: 10.1016/j.jvscit.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
The term neoaortoiliac system (NAIS) was coined by Clagett in 1993 to describe the use of the deep veins in the thigh to replace the aorta and iliac arteries in the setting of graft infection. Since that time, the NAIS procedure has been used to treat a wide array of both infectious and noninfectious conditions affecting the aortoiliac segment. In this article, we present a 10-step description of the NAIS procedure to treat an aortoduodenal fistula in a patient with an infected endovascular aneurysm repair.
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Affiliation(s)
- John F. Eidt
- Department of Surgery, Texas A&M College of Medicine, Bryan, TX,Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX,Correspondence: John F. Eidt, MD, Baylor Scott and White Heart and Vascular Hospital, 621 N Hall St, Ste H-030, Dallas, TX
| | - Angela L. Gucwa
- Department of Cardiothoracic and Vascular Surgery, Luminis Health Doctors Community Medical Center, Lanham, MD
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Mufty H, Michiels T, Van Wijngaerden E, Fourneau I. In situ Reconstruction with Autologous Veins for the Treatment of Infected Abdominal Endografts: Single Center Experience. Surg Infect (Larchmt) 2021; 23:150-154. [PMID: 34978919 DOI: 10.1089/sur.2021.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Vascular graft infection is a feared complication with high mortality and morbidity rates. Complete excision with in situ repair is recommended. We report our experience with patients suffering of abdominal aortic endograft infection undergoing excision and in situ reconstruction with autologous vein. Patients and Methods: All patients who underwent excision of an abdominal aortic endograft and in situ reconstruction with autologous superficial femoral veins between April 2005 and June 2021 were retrospectively reviewed. Primary outcome measures were mortality and reinfection. Secondary outcome measure was patient morbidity. Results: Fifteen patients (14 male; 93%) were included. Twenty percent of the index procedures (N = 3) were performed at our hospital, 80% (N = 12) were referred patients. Three aorto-enteric fistulae were seen. Staphylococci and enterococci were the most common pathogens (N = 8; 53%). In two out of six patients (33%) with an endograft with suprarenal fixation, the suprarenal fixation stent was left in situ. 30-day mortality rate was 6.6% (N = 1). Median follow-up time was 12 months (range 0-85). During follow-up, no reinfection was seen. Serious morbidity was witnessed in 2 patients (sepsis due to bowel leakage (N = 1), pneumonia (N = 2), hemodialysis (N = 1)). Eventration was the most common late morbidity observed (N = 5). Conclusions: Surgical treatment of vascular abdominal endograft infection by in situ reconstruction with autologous deep vein is a challenging procedure. If a multidisciplinary approach is applied and patients are centralized in experienced centers, acceptable mortality and morbidity rates can be achieved.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thirsa Michiels
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Pantaloon Vein Grafts - An Alternative Fix for an Old Problem. Ann Vasc Surg 2021; 74:522.e7-522.e9. [PMID: 33556516 DOI: 10.1016/j.avsg.2021.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pantaloon vein grafts (PVG) were first used to replace infrarenal aortic grafts. However, they may have other applications, such as femoral aortic bifurcation reconstruction. METHODS We herein present 2 different cases, the first with a prosthetic graft infection at the recipient femoral bifurcation, the second for a late occlusion of the femoral bifurcation following endarterectomy and prosthetic patch closure, who were treated with PVG fashioned from the ipsilateral great saphenous vein. CONCLUSION The use of PVG to reconstruct the femoral bifurcation allowed for concurrent axial and profunda femoris artery revascularization, while correcting diameter mismatch with the inflow source and seem particularly suitable for infected operative fields.
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Barbon B, Militello C, De Rossi A, Martella B, Ballotta E. Autologous Great Saphenous Vein Tailored Graft to Replace an Infected Prosthetic Graft in the Groin. Vasc Endovascular Surg 2016; 41:358-61. [PMID: 17704343 DOI: 10.1177/1538574407299805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors propose a technique using the autologous great saphenous vein to replace an infected prosthetic limb graft at the groin. The whole great saphenous vein is incised longitudinally and divided into 2 approximately equal segments, which are sewn side to side. The longitudinal edges of the resulting great saphenous vein are then joined and anastomosed side to side to form a conduit, whose caliber is twice the original vein's diameter. The authors have used this technique to replace 1 limb of a prosthetic aortofemoral bypass infected at the groin. After 5 years, the new venous conduit is patent, with no recurrent infection, dilation, or aneurysmal degeneration. If validated by further experiences, this might be an attractive alternative to restoring flow through clean tissue planes using extra-anatomic bypass or the femoral vein in the infected fields.
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Affiliation(s)
- Bruno Barbon
- Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine; Padova, Italy
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6
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Abstract
Background The use of autologous superficial femoral veins (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery with versatile indications. The SFV autografts exhibit excellent control of infection and durable long-term results in terms of graft patency in prosthetic or arterial infections. In cases of elective use of the SFV, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein. Material and methods The SFV can be harvested distal to the adductor hiatus with a proximal portion of the popliteal vein but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema. Results Early postoperative swelling of the donor leg can be expected but resolves spontaneously in most cases. Chronic mild edema of the leg with a possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare if the anatomical borders for vein harvesting are respected. Temporary therapeutic anticoagulation after vein harvest is subject to individual decision making. Conclusion Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system in the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated.
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Yamamoto Y, Igari K, Toyofuku T, Kudo T, Inoue Y. Late Stent Graft Infection after the Emergency Endovascular Repair of a Secondary Iliac Artery-Enteric Fistula Treated with Graft Removal and In Situ Aortic Reconstruction Using Femoral Veins. Ann Thorac Cardiovasc Surg 2016; 23:113-117. [PMID: 27396381 DOI: 10.5761/atcs.cr.16-00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An arterioenteric fistula is a devastating and life-threatening condition that requires urgent treatment. Less-invasive endovascular treatment has emerged as an alternative to conventional open repair, but postoperative graft infection remains a major concern. We herein report a case of late stent graft infection after emergency endovascular repair of a secondary iliac artery-enteric fistula. The patient was a 63-year-old male who presented with a fever, who had undergone successful endovascular stent grafting for a secondary common iliac artery-enteric fistula 29 months prior. The diagnosis of a stent graft infection was confirmed via computed tomography. He underwent graft removal and in situ reconstruction with femoral vein grafts. At 6-month follow-up, the patient is in a good general condition without any symptoms.
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Affiliation(s)
- Yohei Yamamoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis. J Vasc Surg 2014; 59:675-83. [DOI: 10.1016/j.jvs.2013.09.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 11/23/2022]
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9
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Aerts PD, van Zitteren M, Kotsopoulos AM, van Berge Henegouwen DP, Vriens PW, Heyligers JM. Infected Abdominal Aneurysm due to Salmonella Sepsis: Report of a Unique Case Treated Using the Superficial Femoral Vein. Ann Vasc Surg 2012; 26:279.e5-7. [DOI: 10.1016/j.avsg.2011.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/26/2011] [Accepted: 06/30/2011] [Indexed: 10/14/2022]
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Kuizenga K, Reijnen MM, Tielliu IF, Verhoeven EL, van den Dungen JJ, Zeebregts CJ. Conventional or Endovascular Treatment of Ongoing Mycotic Aortic Aneurysmal Disease? Vascular 2009; 17:103-7. [DOI: 10.2310/6670.2008.00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft. The patient died 5 months later of massive bleeding owing to an aortobronchial fistula deriving from a new thoracic aneurysm proximal to the stent graft. Choices and different modes of treatment are discussed. Endovascular treatment of symptomatic mycotic aortic aneurysm might provide a valid alternative to open repair but may be unsuccessful owing to ongoing infection. In situ replacement using autologous material seems appealing whenever feasible.
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Affiliation(s)
- Kirsten Kuizenga
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Michel M.P.J. Reijnen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Ignace F.J. Tielliu
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Eric L.G. Verhoeven
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Jan J.A.M. van den Dungen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Clark J. Zeebregts
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
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Own Superficial Femoral Vein Versus Silver Bonded Artificial Graft in Patients with Vascular Prosthesis Infection in Aorto-Femoral Position: Treatment Results Comparison. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0025-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nakazawa T, Yasuhara H, Shigematsu H, Muto T. Conservative management of a methicillin-resistant Staphylococcus aureus (MRSA)-infected aortobifemoral graft: report of a case. Surg Today 1999; 29:280-3. [PMID: 10192744 DOI: 10.1007/bf02483023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 63-year-old man was referred to our department for treatment of intermittent claudication in the right lower limb. The preoperative angiogram showed severe stenosis extending from the terminal aorta to the bilateral common femoral arteries, with occlusion of the right superficial femoral artery and the left popliteal artery. He underwent aortobifemoral bypass with thromboendarterectomy of the left common femoral artery, and right graft-popliteal artery bypass. The patient had an uneventful postoperative course; however, 14 days after the operation, a pulsatile mass suddenly appeared in the left groin. Emergency surgery revealed disruption of the left distal anastomosis of the aortobifemoral bypass and therefore, revision, in the form of graft-profunda femoris artery interposition with graft-superficial femoral artery bypass, was performed. Microscopic examination showed colonies of bacteria in the host artery adventitia adjacent to the anastomosis. Culture of the discharge from the right groin operative scar revealed methicillin-resistant Staphylococcus aureus (MRSA). The discharge resolved following the intravenous administration of vancomycin and the local application of vancomycin ointment. There were no operative complications other than the MRSA infection, and the patient was discharged 20 days after revision surgery. In the 14 months since the revision, all grafts have remained patent and there have been no further symptoms of graft infection.
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Affiliation(s)
- T Nakazawa
- First Department of Surgery, University of Tokyo, Japan
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13
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Brown PM, Kim VB, Lalikos JF, Deaton DH, Bogey WM, Powell CS. Autologous superficial femoral vein for aortic reconstruction in infected fields. Ann Vasc Surg 1999; 13:32-6. [PMID: 9878654 DOI: 10.1007/s100169900217] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Autogenous reconstruction is one option available for patients with aortic graft infection or mycotic aneurysms. We reviewed our recent institutional experience with all patients undergoing aortic reconstruction using autologous superficial femoral vein (SFV). Between February 1995 and November 1997, eight patients (five with prosthetic aortic graft infection and three with mycotic aneurysms, including one ruptured mycotic aneurysm) underwent single-stage aortic reconstruction using autologous SFV. Therapy for graft infection included graft excision and replacement with aortobifemoral or aortofemoral (with subsequent cross femoral) grafts fashioned from the SFV. The two patients undergoing elective repair of mycotic aneurysms were treated with extensive SFV patches, and the patient with a ruptured mycotic aneurysm underwent SFV tube grafting. Autogenous reconstruction of the aorta using the SFV in infected fields shows promise for salvage of life and limb during early experiences and short-term follow-up. Morbidity and mortality rates compare favorably with those from existing series, reconstruction is anatomic, and reinfection potential is low. Long-term follow-up and more extensive experience with this technique are needed to establish its role relative to other conventional methods.
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Affiliation(s)
- P M Brown
- Department of Surgery, Division of Vascular Surgery, East Carolina University School of Medicine, Greenville, NC 27834-6819, USA
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Palma JH, Gomes WJ, Almeida DR, Carvalho AC, Brasil LA, Buffolo E. Replacement of infected thoracic aortic prosthesis with a spiral composite vein graft. Ann Thorac Surg 1998; 65:1135-7. [PMID: 9564944 DOI: 10.1016/s0003-4975(98)00049-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We describe a case of a patient who had a ruptured aorta repaired by femorofemoral bypass with an interposition graft and subsequently had a graft infection. The patient was taken to operation and the old graft was removed. It was replaced by a spiral great saphenous vein graft. The patient has been followed up for 36 months with computed tomographic scanning, which has shown that the vein graft has not dilated.
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Affiliation(s)
- J H Palma
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Brazil.
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Nevelsteen A, Lacroix H, Suy R. Infrarenal aortic graft infection: in situ aortoiliofemoral reconstruction with the lower extremity deep veins. Eur J Vasc Endovasc Surg 1997; 14 Suppl A:88-92. [PMID: 9467623 DOI: 10.1016/s1078-5884(97)80162-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Nevelsteen
- Dept of Vascular Surgery, Univ. Clin. Gasthuisberg, Leuven, Belgium
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16
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Franke S, Voit R. The superficial femoral vein as arterial substitute in infections of the aortoiliac region. Ann Vasc Surg 1997; 11:406-12. [PMID: 9236999 DOI: 10.1007/s100169900069] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In situ autogenous reconstruction is an alternative therapy for abdominal aortic prosthetic graft infection. We have used the superficial femoral vein (SFV) as an arterial substitute for proximal aortic anastomosis in seven patients. Six patients presented with aortic perigraft infections and one had a mycotic aneurysm of the infrarenal aorta with a primary aortoenteric fistula. There were no intraoperative but two postoperative deaths. During follow-up (mean: 19.8 months), one patient died at 5 months unrelated to his preceding vascular procedures; the others were doing well with patient SFV grafts 6-36 months after autogenous aortoiliac reconstruction. The SFV is a valuable donor vessel for autogenous reconstruction in the management of aortoiliac prosthetic graft infection. We explain both perioperative deaths in our treatment group with respect to the extent of the underlying infection and the virulence of the causative organism.
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Affiliation(s)
- S Franke
- Department of Vascular Surgery, Surgical University Hospital Würzburg, Germany
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Nevelsteen A, Lacroix H, Suy R. Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease. J Vasc Surg 1995; 22:129-34. [PMID: 7637111 DOI: 10.1016/s0741-5214(95)70106-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE This report evaluates the efficiency of use of the lower extremity deep vein as arterial conduits in the autogenous repair of prosthetic infection after reconstructive aortoiliac surgery. METHODS We reviewed our records for the period 1990 to 1994 of all patients with prosthetic infection after reconstruction for aortoiliac disease, and we selected for this study all those patients who underwent autograft repair with the lower extremity deep veins. RESULTS Included were 15 patients: 12 had previously undergone direct aorto(ilio)femoral reconstruction, and three had an extraanatomic prosthetic graft. Thirteen patients were admitted with primary graft infection, and two were admitted with secondary graft-enteric erosion. Treatment consisted of prosthetic excision and aorto(ilio)femoral reconstruction with the superficial femoral vein. In situ reconstruction was performed in 12 cases. The operative mortality rate was 7%. There were no early graft occlusions. One patient underwent an above-knee amputation because of concomitant femoropopliteal occlusion in the presence of a patent deep venous aortofemoral graft. Early postoperative limb swelling was common and was controlled with bed rest, elastic stockings, or intermittent pneumatic compression. The mean follow-up of this series was 17 months (range 4 to 33 months). Two patients died of unrelated causes. One graft occluded after 16 months. There were no reinfections, and all but one patient resumed normal daily activities. Disability from removal of the deep veins was minimal: only one patient continues to wear elastic stockings for limb swelling and shows signs of venous hypertension more than 2 years after surgery. CONCLUSION Harvesting of the lower extremity deep veins is well tolerated. Autogenous reconstruction with these veins provides good potential for salvage of life and limbs in case of prosthetic infection. A longer period of follow-up is required to study the long-term behavior of these grafts and to allow definite comparison with more conventional approaches.
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Affiliation(s)
- A Nevelsteen
- Department of Vascular Surgery, University Clinic Gasthuisberg, Leuven, Belgium
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