Unilateral inline replacement of infected aortofemoral graft limb with femoral vein

Abstract

This limited series demonstrates excellent graft patency with a low persistent infection rate. Thus, in patients with localized graft infection, partial excision with preservation of the proximal synthetic graft is an acceptable alternative when patient factors preclude complete graft excision.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…Retrospective studies reported no re-infection after 2.5 years in 11 patients after interposition of unilateral silver coated grafts, 163 no re-infection after partial interposition with cryopreserved allografts in 10 patients after three years, 185 and a 9.5% re-infection rate after partial resection with autologous vein interposition in 20 patients after 72 months. 186 Limited resection of only infected material and reconstruction by obturator canal bypass (n ¼ 18) or part of a bifurcated graft (n ¼ 34) was also proposed with reinfection rates of 6% and 0%, respectively, and no amputation at 36 months. 187 Other series reported a 47% (n ¼ 7/ 15 patients) infection rate of the contralateral limb after 39 months, when partial resection of an aortobifemoral VGI and EAR was performed.…”

A Meta-Analysis of Outcomes of In Situ Reconstruction after Total or Partial Removal of Infected Abdominal Aortic Grafts?

“…As expected, none of the studies were randomized control trials. The primary characteristics of clinical studies and covariates used in this meta-analysis are detailed online in (Supplementary, Appendix F) [7][8][9][10]17,18,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”

“…The mean number of patients across all studies was 50 (range: 2-220). There were 887 TR (84 %), and 165 PR (16%) with 6 studies (382 patients) combining TR (259 patients) and PR (123 patients) [ 9,29,32,34,38,40], 11 studies with solely TR (628 patients: 335 cryopreserved allografts, 259 autogenous veins, 23 standard polyesters/ PTFE, and 11 rifampicin-bonded polyesters) [7,8,10,28,30,31,33,35,39,41,42] and 4 studies with solely PR (42 patients: 23 autogenous veins, 11 silver-coated polyesters, and 8 standard polyesters/PTFE) [17,18,36,37].…”

“…Thus, it was suggested that the premise of a more limited aortic reconstruction might benefit the patient by avoiding aortic clampage, reducing physiological stress, and limiting the extent of dissection needed to excise the entire graft. On the other hand, concerning the extent of AGI, numerous authors [36][37][38][39][41][42][43] agree that for pangraft infection TR is the most advisable, and when AGI is localized, PR appears recommendable [17,18]. However, there are numerous other clinical scenarios where optimal treatment is not clearly defined.…”

“…In a recent meta-analysis, ISR was associated with a lower occurrence of events, (early mortality, amputation, and reinfection) than EAR, and these results suggest that ISR may be considered as a first-line treatment [13]. On the other hand, partial graft preservation techniques are becoming increasingly popular as a method to treat established graft infection [14][15][16][17][18]. However, partial resection (PR) varies widely in the series, there is no consensus for assessing the extent of infection on the graft, indications are not clear, and outcomes reported in the series are limited.…”