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Autogenous Femoral Vein for Secondary Repair of Subclavian Arteries: A Salvage Solution for Complex Clinical Scenarios. Ann Vasc Surg 2020; 67:566.e5-566.e9. [DOI: 10.1016/j.avsg.2020.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/09/2020] [Accepted: 02/27/2020] [Indexed: 11/20/2022]
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2
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Management of patch infections after carotid endarterectomy and utility of femoral vein interposition bypass graft. J Vasc Surg 2019; 69:1815-1823.e1. [DOI: 10.1016/j.jvs.2018.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022]
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3
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Abstract
The management of infected prosthetic grafts is one of the most challenging problems facing vascular surgeons. High mortality and morbidity rates with traditional treatment have led many surgeons to consider different and novel strategies. Diagnosis is usually straightforward, but occasionally is unclear even after extensive clinical and radiologic investigations. Although routine total graft excision for all infected aortic grafts is still favored by some vascular surgeons, most favor only partial graft excision if only the distal limb of the graft is involved. Placement of in situ autologous vein or cryopreserved grafts have gained popularity, and investigations are continuing regarding the use of in situ antibiotic and silver-coated prosthetic grafts. In this article the authors review the incidence and etiology of aortic graft infections, methods to prevent these complications, the diagnosis of infected aortic grafts, and lastly the management of these complicated cases, including total graft excision and partial and complete graft preservation.
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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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Mussa FF, Hedayati N, Zhou W, El-Sayed HF, Kougias P, Darouiche RO, Lin PH. Prevention and treatment of aortic graft infection. Expert Rev Anti Infect Ther 2014; 5:305-15. [PMID: 17402845 DOI: 10.1586/14787210.5.2.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prosthetic vascular graft infection remains one of the most challenging surgical problems for vascular surgeons. This condition is classically associated with high morbidity and mortality rates. Accurate diagnosis of a vascular graft infection can typically be made based on a thorough history and physical examination; although, infrequently, an extensive radiological evaluation is necessary to establish the clinical finding. Complete graft excision and extra-anatomic bypass grafting remains a commonly accepted surgical treatment strategy. Recent clinical data have supported other treatment modalities, including the use of in situ antibiotic-impregnated graft replacement, in situ allograft replacement and in situ autologous graft replacement. This article will review the pathobiology of aortic graft infection, as well as methods to prevent a prosthetic graft infection. Furthermore, various surgical treatment modalities of aortic graft infection will be discussed.
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Affiliation(s)
- Firas F Mussa
- The Michael E DeBakey VA Medical Center, Division of Vascular Surgery & Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Chavez LA, Leon LR, Hughes J, Mills JL. Aneurysmal degeneration of deep lower extremity vein conduits used for vascular reconstruction. Vasc Endovascular Surg 2013; 48:193-200. [PMID: 24352332 DOI: 10.1177/1538574413503714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Successful outcomes have been reported with the use of femoropopliteal vein (FPV) grafts as arterial conduits. We identified 2 patients with a rare complication, true, nonanastomotic aneurysmal degeneration. METHODS Patients from 1997 through 2009 that utilized FPV grafts for revascularization were analyzed. We contacted survivors by phone and conducted a literature search of FPV aneurysms. RESULTS Of the total of 14 patients in our practice whose FPV was used as a conduit during the study period, 2 developed nonanastomotic FPV graft aneurysms. The mean follow-up time was 33.44 months. Literature review uncovered only 1 previously published case of FPV aneurysmal degeneration. CONCLUSIONS Our experience suggests that nonanastomotic aneurysms of FPV grafts may occur more often than those suspected previously. Our study represents the first reports of aneurysmal degeneration affecting FPV grafts when used for vascular reconstructions.
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Affiliation(s)
- LeAnn A Chavez
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS), Arizona Health Science Center (AHSC) and Tucson Medical Center-Vascular and Endovascular Surgery Sections, Tucson, Arizona, USA
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Brahmanandam S, Clair D, Bena J, Sarac T. Adjunctive use of the superficial femoral vein for vascular reconstructions. J Vasc Surg 2012; 55:1355-62. [DOI: 10.1016/j.jvs.2011.11.129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 10/28/2022]
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van Zitteren M, van der Steenhoven T, Burger D, van Berge Henegouwen D, Heyligers J, Vriens P. Spiral Vein Reconstruction of the Infected Abdominal Aorta Using the Greater Saphenous Vein: Preliminary Results of the Tilburg Experience. Eur J Vasc Endovasc Surg 2011; 41:637-46. [DOI: 10.1016/j.ejvs.2011.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/25/2011] [Indexed: 11/28/2022]
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9
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Benaduce Casella I, Presti C, Yamazaki Y, Vassoler AA, Furuya LA, Sabbag CD. A duplex scan-based morphologic study of the femoral vein: Incidence and patterns of duplication. Vasc Med 2010; 15:197-203. [DOI: 10.1177/1358863x09358918] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The presence of femoral vein (FV) duplicity has potential influence in the misdiagnosis of deep vein thrombosis. Also, FVs are suitable vascular substitutes, especially in the substitution of infected prosthetic grafts. The objective of this study was to describe the prevalence, anatomic patterns and characteristics of FV duplicity in adult individuals by duplex scan examination. A total of 174 adult individuals were submitted to duplex-scan examinations of both lower limbs. Individuals with duplex signs of present or previous DVT or with poor quality duplex images were excluded from the investigation. The remaining group consisted of 157 individuals (94 females), with a total of 314 limbs studied. Along with the conventional duplex investigation sequence, the FV was scanned both in transversal and longitudinal views. The number, extension and diameter of FVs were documented. It was found that 173 limbs (55.1%) had duplicated FV. Duplicity in the whole femoral extension was noted in 82 (26.1%) limbs, and out of these only 28 (8.9% of the overall number) had accessory veins with a diameter approximate to (at least 75%) the main FV. Partial (distal or proximal) duplications were seen in 89 (28.3%) limbs. A third FV was present in 28 limbs. As a possible vascular substitute, 99.0% of the main FVs and 25.4% of the accessory veins presented diameters superior to 6 mm, a suitable value for iliac substitution. In conclusion, FV duplicity is frequent, and occurred in 55% of all limbs studied. However, complete extension duplicated veins with similar diameters was an uncommon condition, noticed in fewer than 10% of limbs.
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Affiliation(s)
| | - Calógero Presti
- Division of Vascular Surgery, Hospital Regional Sul, São Paulo, Brazil
| | - Yumiko Yamazaki
- Division of Vascular Surgery, Hospital Regional Sul, São Paulo, Brazil
| | | | - Luiz A Furuya
- Division of Vascular Surgery, Hospital Regional Sul, São Paulo, Brazil
| | - Claudio D Sabbag
- Division of Vascular Surgery, Hospital Regional Sul, São Paulo, Brazil
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Alcocer F, Zazueta E, Montes de Oca J. The Superficial Femoral Vein: A Valuable Conduit for a Short Renal Vein in Kidney Transplantation. Transplant Proc 2009; 41:1963-5. [DOI: 10.1016/j.transproceed.2009.02.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 02/23/2009] [Indexed: 11/17/2022]
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Mahendra A, Gortzak Y, Ferguson PC, Deheshi BM, Lindsay TF, Wunder JS. Management of vascular involvement in extremity soft tissue sarcoma. Recent Results Cancer Res 2009; 179:285-299. [PMID: 19230547 DOI: 10.1007/978-3-540-77960-5_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advances in adjuvant treatment protocols and improvements in imaging techniques have helped improve the limb-salvage rate for extremity soft tissue sarcomas to approximately 95%. Moreover, improvements in operative techniques have enabled successful limb-salvage surgery to be performed even in the face of vascular invasion or encasement by tumor. En bloc resection of major vascular structures with the tumor and reconstruction with reversed saphenous vein grafts, femoral venous grafts, or synthetic grafts has proved to be a feasible option in limb-salvage surgery. However, the surgical oncologist and patient should be aware that although overall function is only slightly worse after these procedures, individual functional results are less predictable. In addition, procedures requiring vascular resection and reconstruction are associated with an increased risk of complications, including amputation.
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Affiliation(s)
- Ashish Mahendra
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Reid JDS, MacDonald PS. Removing the Infected Aortofemoral Graft Using a Two-Stage Procedure with a Delay Between the Stages. Ann Vasc Surg 2005; 19:862-7. [PMID: 16200471 DOI: 10.1007/s10016-005-7759-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study describes the results of a procedure for removing the infected aortofemoral graft using a two-stage procedure with a delay between the stages. The objective was to lessen the morbidity and mortality associated with removing an infected graft through a single operation. Eight consecutive patients were treated in this manner over a 6-year span. The indications for surgery were infected groin false aneurysms in three, chronic draining sinuses involving the prosthetic graft in four, and an open groin infection involving graft in one. There were five males and three females, with ages ranging 47-83 years (mean = 63). The mean operative time of the first-stage operation was 5.1 hr (range 3.0-7.7), and the mean blood transfusion requirement was 1.7 units. The mean operative time of the second stage operation was 3.5 hr (range 3.5-7.6), and the mean blood transfusion requirement was 2.5 units. In six patients, the hospital course was uncomplicated, with a mean hospital stay of 8.4 days for the initial stage and 9.2 days for the second stage. Two patients had complicated postoperative courses with hospital stays of >30 days. There was no operative or graft-related late mortality. No patients were lost to follow-up. One patient died of unrelated causes with a patent graft at 22 months postsurgery. All other patients remain well with patent grafts, without requiring revisions at a mean follow-up of 33 months (range 6-73). A two-stage approach with a delay between the stages may reduce the morbidity and mortality associated with the removal of an infected aortobifemoral graft.
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Affiliation(s)
- John D S Reid
- Division of Vascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Nevelsteen A, Baeyens I, Daenens K, Fourneau I. Regarding “deep vein harvest: predicting need for fasciotomy”. J Vasc Surg 2004; 40:403; author reply 403-4. [PMID: 15303273 DOI: 10.1016/j.jvs.2004.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Németh Z, Dömötör G, Tálos M, Barabás J, Ujpál M, Szabó G. Resection and replacement of the carotid artery in metastatic head and neck cancer: literature review and case report. Int J Oral Maxillofac Surg 2004; 32:645-50. [PMID: 14636618 DOI: 10.1054/ijom.2002.0419] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metastases of advanced tumours of the oral cavity sometimes affect the cervical segments of the carotid arteries. The situation is worse in the 5-10% of cases in which the metastasis involves the common or internal carotid to such an extent that resection and replacement of the artery become necessary. Following clinical, CT/NM, and angiographic examinations, a surgical plan for the resection and reconstruction of the affected vascular segment is formulated. In preparing a treatment plan, emphasis must be placed on the expected quality of life, and careful consideration must be given to the extent of the operation.A survey of the international literature reveals that the reported mean 1-year complaint free survival rate after resection and reconstruction varies between 0 and 44%. In our experience, the wall of the carotid vessels is very resistant to tumour invasion in a large majority of patients. When radical surgery and reconstruction are carried out in the same session, does this increase the long-term cure rate and lengthen patient survival? A number of authors agree that radical interventions do not alter the survival indices significantly, but may improve the quality of life and regional control of the disease. The controversy over this topic is illustrated by means of a case report.
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Affiliation(s)
- Zs Németh
- Department of Oral and Maxillofacial Surgery, Semmelweis University, Faculty of Dentistry, Budapest, Hungary.
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Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg 2003; 25:240-5. [PMID: 12623336 DOI: 10.1053/ejvs.2002.1835] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins. METHODS forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied. Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan. The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins. After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan. RESULTS there were four in-hospital deaths (8%). One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%). With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%). There were no late amputations and only two late graft limb stenoses (4%). We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91%. There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection. CONCLUSION in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.
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Affiliation(s)
- K Daenens
- Center for Vascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium
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