Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Treatment of Aortic Graft Infection with Autologous Femoral Vein
There are no simple solutions to aortic graft infection, but a thoughtful approach to the surgical treatment of this condition minimizes the risk of major morbidity and mortality. No single operation is appropriate for all patients, so a working knowledge of the various options is critical to optimize outcomes.
Graft Excision
Eradication of the infection requires a combination of graft excision, wide débridement, and adjunctive antimicrobial therapy. Partial graft excision has been advocated for infections that appear on imaging to be localized to a single limb of an aortobifemoral bypass (AFB). Our extensive experience with aortic graft infections suggests that recurrent infection is not uncommon with this approach.
Options for Reconstruction
The options for aortic reconstruction after graft excision include extra-anatomic bypass and in-situ reconstruction. There are advantages and disadvantages of both approaches ( Table 1 ).
TABLE 1
Reconstruction Options After Excision of Infected Aortic Grafts
| Reconstruction Option | Advantages | Disadvantages |
|---|---|---|
| Extra-anatomic bypass | Staging possible Least physiologic stress |
Poor long-term patency Risk of amputation Aortic stump blowout Graft reinfection Need for anticoagulation |
| Redo in-situ prosthesis | Convenience No aortic stump Good patency |
Reinfection risk Chronic ABX |
| In-situ human allograft | Convenience No aortic stump |
Reinfection risk Acute thrombosis Chronic ABX |
| In-situ autogenous FPV | Resistant to reinfection Superior patency No aortic stump |
Long operation Highest physiologic stress |
Chronic ABX , Need for long-term antibiotic therapy; FPV , femoropopliteal vein grafting.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here