Spiral Vein Reconstruction of the Infected Abdominal Aorta Using the Greater Saphenous Vein: Preliminary Results of the Tilburg Experience

Abstract

Spiral vein reconstruction using the GSV showed good short-term survival and limb salvage. It, therefore, might be considered as an attractive treatment method for vascular infections of the abdominal aorta. Still, more follow-up is needed to evaluate long-term results.

Report of two in situ reconstructions with a saphenous spiral vein graft of Coxiella burnetii-infected aneurysms of the abdominal aorta

“…The GSV was used as a spiral vein conduit for aortic reconstruction, and long-term antibiotic administration was initiated. Those cases have not been previously described in van Zitteren et al 12…”

“…CT-guided FNA of peri-aortic fluid collections is proven to be a safe and useful tool after carefully assessing the ideal patient position and biopsy site 13 diagnosis of infection, determine the causing pathogen, and adjust antibiotics. 12 No complications occurred during the FNA procedure. Open surgery with spiral vein reconstruction was performed (see Surgical Procedure section).…”

“…The surgical procedure has been previously described in full detail by van Zitteren et al 12 Preoperative duplex examinations were performed to evaluate the suitability of the GSV for spiral vein reconstruction by measuring the diameters and length. The formula 2r was used to calculate the total length of GSV that is needed to construct a suitably fitting vein graft.…”

“…The GSV was harvested (range, 30-45 minutes), cut open longitudinally, and tightly placed on a 15-mm-diameter tube to construct a spiral graft using continuous sutures (6.0 Vascufil [Covidien, Mansfield, Mass]; range, 90-120 minutes). 12,14 The vein was not devalved because it was constructed into a spiral vein. Laparotomy was performed simultaneously where intravenous heparin (range, 2500-5000 units) was given before clamping of the aorta.…”

“…11 Spiral vein reconstruction overcomes those problems because the spiral vein diameter can be adjusted according to the diameter of the abdominal aorta. We have suggested using the great saphenous vein (GSV) as a spiral graft to reconstruct the aorta, 12 which has not been described for C. burnetiiinfected aneurysms.…”