AUTOGENOUS RECONSTRUCTION WITH THE LOWER-EXTREMITY DEEP VEINS - AN ALTERNATIVE TREATMENT OF PROSTHETIC INFECTION AFTER RECONSTRUCTIVE SURGERY FOR AORTOILIAC DISEASE

Purpose: This report evaluates the efficiency of use of the lower extr emity deep veins as arterial conduits in the autogenous repair of pros thetic 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 recons truction, and three had an extraanatomic prosthetic graft. Thirteen pa tients were admitted with primary graft infection, and two were admitt ed with secondary graft-enteric erosion. Treatment consisted of prosth etic excision and aorto(ilio)femoral reconstruction with the superfici al 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 concomitan t femoropopliteal occlusion in the presence of a patent deep venous ao rtofemoral graft. Early postoperative limb swelling was common and was controlled with bed rest, elastic stockings, or intermittent pneumati c compression. The mean follow-up of this series was 17 months (range 4 to 33 months). Two patients died of unrelated causes. One graft occl uded after 16 months. There were no reinfections, and all but one pati ent resumed normal daily activities. Disability from removal of the de ep veins was minimal: only one patient continues to wear elastic stock ings for limb swelling and shows signs of venous hypertension more tha n 2 years after surgery. Conclusion: Harvesting of the lower extremity deep veins is well tolerated. Autogenous reconstruction with these ve ins provides good potential for salvage of life and limbs in case of p rosthetic infection. A longer period of follow-up is required to study the long-term behavior of these grafts and to allow definite comparis on with more conventional approaches.