O Ehsan1, C P Gibbons. 1. Department of Vascular Surgery, Morriston Hospital, Swansea, SW6 6NL, UK.
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.
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.