Complex aortofemoral prosthetic infections - The role of autogenous superficial femoropopliteal vein reconstruction

Background: With increasing experience, we have encountered patients with c omplex aortofemoral prosthetic infections in whom extra-anatomic bypass (EA B) is not an option. Hypothesis: Autogenous superficial femoropopliteal vein (SFPV) aortic recon struction provides a limb-saving and lifesaving alternative with acceptable morbidity and mortality. Design: Retrospective review. Setting: University-based county, private, and Veterans Affairs hospitals. Patients: Seventeen patients with infected aortofemoral bypasses in whom co nventional EAB was impossible because of infection of previously placed EAB , massive groin and/or thigh sepsis, or both. Main Outcome Measures: Morbidity and mortality. Results: Multiple previous operations were common (mean, 4 per patient) and included EAB (n = 11), re placement aortofemoral bypass (n = 4), prostheti c femoropopliteal bypass (n=7), and thoracobifemoral bypass (n = 1); all by passes became infected. Overall, 11 patients had sepsis at the time of pres entation. Of the patients with massive groin infection, 7 had extensive dee p infections involving most of the proximal thighs or retroperitoneum, 4 ha d enterocutaneous fistulae, and 2 had necrotizing fasciitis of the lower ab domen and thigh. Polymicrobial infections were common (n = 9). Four patient s (24%) died in the perioperative period, 8 (47%) suffered major complicati ons, and 4 (24%) underwent major amputations. Mortality in this group of pa tients was 3 times that of all other patients undergoing autogenous SFPV ao rtic reconstruction for prosthetic infection (8%). Amputation rates were al so increased (24% vs 6%). The mean +/- SD follow-up time is 23 +/- 21 month s. All patients maintained patent SFPV reconstructions. Conclusions: In the setting of complex aortofemoral prosthetic infections, autogenous SFPV aortic reconstruction is a useful option for patients in wh om EAB is impossible and limb loss and/or death would be inevitable without revascularization.