Autogenous graft replacement of infected prosthetic grafts in the femoral position.

Infected prosthetic grafts in the femoral position remain among the most challenging problems in vascular surgery. Over the past 2 years, 11 patients with this critical condition have undergone graft reconstruction with autogenous tissue as described by Ehrenfeld. All infected prosthetic material was removed and replaced by an autogenous graft. The autogenous grafts were constructed with endarterectomized superficial femoral, iliac, and aortic segments as well as portions of saphenous and cephalic veins. This procedure has proven successful, resulting in only one amputation (undertaken with a still functioning autogenous graft) in the series. There was one postoperative death. Six grafts failed in long-term follow-up, due in all cases to inadequate flow because of stenosis of the saphenous vein portion of the autogenous reconstruction. However, the patients were usually free of infection by this time and underwent successful prosthetic reconstruction.