Ll. Gordon et al., Complex aortofemoral prosthetic infections - The role of autogenous superficial femoropopliteal vein reconstruction, ARCH SURG, 134(6), 1999, pp. 615-620
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.