The efficacy of autologous femoropopliteal vein reconstruction for primary aortic and aortic graft infection

Ann Vasc Surg. 2015 Aug;29(6):1188-95. doi: 10.1016/j.avsg.2015.03.043. Epub 2015 May 22.

Abstract

Background: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection.

Methods: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected aorta between 2012 and 2014. Three patients had a primary mycotic aneurysm caused by a Salmonella or Coxiella burnetti infection. Seven patients were treated previously for aortic aneurysms with a conventional Dacron vascular prosthesis and 4 with an endovascular prosthesis. All infected prostheses were explanted via median laparotomy with subsequent debridement of the aortic aneurysm wall. Aortic reconstruction was performed with 1 or 2 superficial femoropopliteal veins, interpositioning the greater omentum when possible. The primary outcome measure was 30-day mortality. Secondary outcome measures were reoperation, operating time, amputation rate, length of intensive care unit (ICU) and hospital stay, reinfection rate, and limb edema requiring compression therapy.

Results: The 30-day mortality was 28%. Two patients died of an abdominal sepsis, one patient of a cerebrovascular accident and another of a hypovolemic shock. One patient died at home 2 years after surgery of unknown cause. Four patients required a reoperation. The median intraoperative blood loss was 1,500 mL (500-8000). Median operating time was 364 min (264-524). Median length of ICU stay was 3.5 days (1-47), and median hospital stay was 20 days (10-47). There were no limb amputations. Mild edema of the donor leg was documented in 2 patients. Compression stockings were not worn by any patients. Postoperative antibiotic treatment was administered for at least 6 weeks. No recurrent infections were diagnosed.

Conclusions: Autologous venous reconstruction of the aorta offers advantages over other therapeutic approaches and deserves a prominent place in the treatment of the primary infected aorta or an infected aortic prosthetic graft.

MeSH terms

  • Aged
  • Aneurysm, Infected / diagnosis
  • Aneurysm, Infected / microbiology
  • Aneurysm, Infected / mortality
  • Aneurysm, Infected / surgery*
  • Anti-Bacterial Agents / therapeutic use
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / microbiology
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Aortography / methods
  • Autografts
  • Blood Vessel Prosthesis / adverse effects*
  • Female
  • Femoral Vein / transplantation*
  • Humans
  • Male
  • Middle Aged
  • Plastic Surgery Procedures* / adverse effects
  • Plastic Surgery Procedures* / mortality
  • Popliteal Vein / transplantation*
  • Positron-Emission Tomography
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / surgery*
  • Q Fever / diagnosis
  • Q Fever / microbiology
  • Q Fever / mortality
  • Q Fever / surgery*
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Salmonella Infections / diagnosis
  • Salmonella Infections / microbiology
  • Salmonella Infections / mortality
  • Salmonella Infections / surgery*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents