Long-term outcome after treatment of aortic graft infection with staged extraanatomic bypass grafting and aortic graft removal

Objective: The purpose of this study was to determine long-term outcome in patients with infected prosthetic aortic grafts who were treated with extra -anatomic bypass grafting and aortic graft removal. Methods: Between January 1989 and July 1999, 36 patients were treated for a ortic graft infection with extra-anatomic bypass grafting and aortic graft removal. Extra-anatomic bypass graft types were axillofemoral femoral (5), axillofemoral (26; bilateral in 20), axillopopliteal (3; bilateral in 1) an d axillofemoral/axillopopliteal (2). The mean followup was 32.3 +/- 4.8 mon ths. Results: Pour patients (11%) died in the postoperative period, and two pati ents died during follow-up as a direct consequence of extra-anatomic bypass grafting and aortic graft removal (one died 7 months after extra-anatomic bypass graft failure, one died 36 months after aortic stump disruption). On e additional patient died 72 months after failure of a subsequent aortic re construction, so that the overall treatment-related mortality was 19%, wher eas overall survival by means of life table analysis was 56% at 5 years. No amputations were required in the postoperative period, but four patients ( 11%) required amputation during follow-up. Twelve patients (35%) had extra- anatomic bypass graft failure during follow-up, and six patients underwent secondary aortic reconstruction (thoracobifemoral [2], iliofemoral [2], fem orofemoral [2]). However, with the exclusion of patients undergoing axillop opliteal grafts (primary patency 0% at 7 months), only seven patients (25%) had extra-anatomic bypass graft failure, and only two patients required am putation (one after extra-anatomic bypass graft removal for infection, one after failure of a secondary aortic reconstruction). Furthermore, primary a nd secondary patency rates by means of life table analysis were 75% and 100 % at 41 months for axillofemoral femoral grafts and 64% and 100% at 60 mont hs for axillofemoral grafts. Only one patient required extra-anatomic bypas s graft removal for recurrent infection, and only one late aortic stump dis ruption occurred. Conclusions: Staged extra-anatomic bypass grafting (with axillofemoral bypa ss graft) and aortic graft removal for treatment of aortic graft infection are associated with acceptable early and long-term outcomes and should rema in a primary approach in selected patients with this grave problem.