Ag. Hakaim et al., AUTOGENOUS VEIN GRAFTS FOR FEMOROFEMORAL REVASCULARIZATION IN CONTAMINATED OR INFECTED FIELDS, Journal of vascular surgery, 19(5), 1994, pp. 912-915
Purpose: The purpose of this study was to determine the indications an
d the long-term results for femorofemoral revascularization with autog
enous vein grafts (AVG) rather than conventional synthetic materials.
Methods: A consecutive series of 13 men and 12 women (mean age 64 year
s) receiving femorofemoral AVG was collected during a retrospective re
view of our experience from 1979 to 1992. Sixteen of these 25 patients
required revascularization for acute ischemia in the presence of pote
ntial groin contamination (group 1), and the remaining nine had frank
infections involving previous synthetic grafts (group 2). New grafts w
ere constructed with the greater saphenous vein in 23 patients (92%) a
nd with the cephalic vein in two. Results: One patient in each group (
8%) died after operation with patent grafts. Preoperative and postoper
ative ankle/brachial indexes (ABI) were available for 12 patients in g
roup 1 and for seven patients in group 2. There was significant improv
ement in the ABI among 11 patients with ischemia in group 1 (mean 0.33
+/- 0.13; p = 0.0001), whereas no change in the ABI occurred in conju
nction with the replacement of patent infected grafts among six patien
ts in group 2 (mean 0.04 +/- 0.17; p = NS). One patient from each grou
p sustained a reduction in postoperative ABI for the recipient limb de
spite a patent AVG. Cumulative 3-year survival and primary patency est
imates for all 23 operative survivors were 63% and 75%, respectively.
Late results seemed to be comparable in group 1 and group 2, but each
contained too few patients for adequate analysis. Conclusions: Despite
their infrequent use, AVG seem to represent a reasonable alternative
to synthetic bypass for femorofemoral revascularization in patients ha
ving either contaminated wounds or established graft infections.