Creation of a Neo-Aortoiliac System from Lower Extremity Deep and Superficial Veins

Abstract

NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.

Late Stent Graft Infection after the Emergency Endovascular Repair of a Secondary Iliac Artery-Enteric Fistula Treated with Graft Removal and In Situ Aortic Reconstruction Using Femoral Veins

“…11) In the present case, the patient was successfully treated by removing the infected graft and performing in situ reconstruction with FV grafts. Aortic reconstruction with FV grafts was first introduced in 1993 by Clagett et al 12) and Nevelsteen et al 13) The reported 30-day mortality rate is less than 10%, with a 5-year survival rate of 50%-60% and a 5-year limb salvage rate of about 90%. 14,15) The reinfection rate is below 2%, 16) indicating that reconstruction with the FV grafts is the most effective method of preventing reinfection.…”

Current Management of Vascular Infections

“…[32] In these cases, superficial femoral vein harvesting has a strong indication. [33,34] Preoperative vein mapping is important. In cases of aortic reconstruction, with larger aortic diameter, "pantaloon technique" can be applied.…”

Abdominal Aortic Graft Infection

“…However, the reinfection rate is high and unpredictable, and patients must undergo lifelong antibiotic therapy. d. Neo-aortoiliac bypass procedures Because of the limitations of the other procedures, the use of in situ autogenous venous reconstruction technique, also termed neoaortoiliac system or NAIS procedure, has known great advocacy since its first description by Clagett in 1993 (Clagett et al, 1993). We should give credit to Erenfield who introduced first the concept of autogenous replacement of infected aortic grafts but it was Clagett' s introduction of the graft constructed of femoral popliteal veins that made the routine use of this method feasible.…”

“…The 5-year patency rates for aortoiliac/aortofemoral reconstructions using FPV grafts range from 85% to 100% (Beck et al, 2008). According to the conventional method described by D'Addio and Clagett in 1993, the patient is prepared and draped from the nipples to the feet under general anesthesia (Clagett et al, 1993). A longitudinal incision along the course of the Sartorius muscle is used to expose an adequate length of the deep femoral and popliteal veins.…”