A 10-year experience of using femoro-popliteal vein for re-vascularisation in graft and arterial infections

Eur J Vasc Endovasc Surg. 2009 Aug;38(2):172-9. doi: 10.1016/j.ejvs.2009.03.009. Epub 2009 Apr 11.

Abstract

Background: Infected prosthetic grafts and mycotic aneurysms carry a high mortality and morbidity rate, with a substantial risk of persistent graft infection, but there is evidence that this can be minimised by using femoro-popliteal vein for arterial reconstruction after debridement and graft excision. We present our 10-year experience of this technique.

Methods: Forty-six patients underwent 48 arterial reconstructions with femoro-popliteal vein (24 aortic). Six had mycotic aneurysms (three aortic) and 40 had graft infections (16 aortic).

Results: There were two early postoperative deaths (4.3%) and two patients with pre-existing ischaemia underwent major amputation despite a patent graft. Median follow-up was 4.1 ears (range: 2 months to 10 years). Patient survival was 70% and limb salvage 96% at 5 years. Primary graft patency was 75% and 62% and secondary patency 93% and 91% at 2 and 5 years, respectively. Two patients required further surgery for recurrent infection. Anastomotic or graft stenosis occurred in 11 patients (24%). There were three major wound infections. Donor-limb swelling was transient.

Conclusion: For arterial and prosthetic graft infections, femoro-popliteal vein is an excellent conduit for vascular reconstruction after drainage and debridement of infected tissue and graft material under antibiotic cover, providing good long-term survival and limb salvage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amputation, Surgical
  • Aneurysm, False / etiology
  • Aneurysm, Infected / microbiology
  • Aneurysm, Infected / mortality
  • Aneurysm, Infected / surgery*
  • Anti-Bacterial Agents / therapeutic use
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Debridement
  • Device Removal
  • Drainage
  • Edema / etiology
  • Female
  • Femoral Vein / transplantation*
  • Graft Occlusion, Vascular / etiology
  • Humans
  • Kaplan-Meier Estimate
  • Limb Salvage
  • Male
  • Middle Aged
  • Popliteal Vein / transplantation*
  • Prospective Studies
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / surgery*
  • Recurrence
  • Reoperation
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures* / adverse effects
  • Vascular Surgical Procedures* / mortality

Substances

  • Anti-Bacterial Agents