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Aortic infection is a challenging condition. Fortunately, surgical revision of infected aorta with in situ reconstruction can provide long-term cure. The material for aortic repair remains an area of debate. The Omniflow II (LeMaitre Vascular, Burlington, Mass) prosthesis is a biosynthetic graft made to resist long-term degeneration and allows growth of host tissue with reduction of the risk of arterial infection. It has already been used for peripheral bypass with very low infection rates. Herein, we describe an original case of first-line native aorta replacement by a straight Omniflow II biologic prosthesis for infected aortic aneurysm. Keywords: Aorta, Infection, Biosynthetic graft

Objective Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. Material and methods A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). Results The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. Conclusion This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.

Introduction: Success with the neoaortoiliac system (NAIS) bypass has previously been reported. Drawbacks to this procedure include prolonged operative times and significant morbidity. The aim of this study was to evaluate whether a 2-team approach in addition to a consistent anastomosis technique reduces the operative time of the NAIS procedure. Methods: A single-center retrospective review was performed for operations using femoral vein in arterial reconstruction from 2003 to 2012. Results: A total of 40 patients, 25 men and 15 women, were included for analysis. Median operative time for all operations was 300 minutes (interquartile range). Thirty-day mortality was 7.5% (n = 3). Assisted primary patency at 1 year was 100%. Conclusion: A 2-surgical team approach can reduce the operative time by up to 50%. This improves the attractiveness of this procedure, particularly when recalling that the treatment is definitive by virtue of its eradication of the source of infection.

Virologic analysis of tissues from a patient with giant cell arteritis (GCA) who was treated with corticosteroids and died of extensive necrotizing granulomatous arteritis revealed widespread varicella-zoster virus (VZV) antigen in multiple large arteries. Long-term treatment with corticosteroids likely potentiated VZV infection. Acknowledgment: The authors thank Marina Hoffman for editorial review and Cathy Allen for word processing and formatting.

Treatment of aortic field infections is challenging and usually involves removal of the infected segment with re-vascularization of the distal arterial tree with infection-resistant graft material or via an extra-anatomical route. We present three cases of arterial infection treated successfully using cryopreserved superficial femoral artery homografts as aortoiliac substitutes. This new approach is a potential alternative to other in situ re-vascularization techniques.

The treatment of mycotic abdominal aortic aneurysms remains a significant surgical challenge associated with significant morbidity and mortality. In the following case report, we describe our successful management of a patient with a mycotic abdominal aortic aneurysm using two cryopreserved superficial femoral artery allografts (available from the UK NHS tissue bank) to create a Y-shaped allograft to permit immediate aortic reconstruction after surgical debridement. To our knowledge, this is the first time such a reconstruction has been reported in the literature.

The excision of an infected aortobifemoral Dacron graft 9 years after implantation and bilateral axillofemoral Dacron bypass reconstruction led to reinfection of the extra-anatomic bypass grafts. A new aorto-bifemoral reconstruction was performed using cryopreserved homografts delivered by the European Homograft Bank in Brussels and both axillo-femoral prostheses were removed. No signs of infection and no alterations of the homografts can be detected 3 years later.

Autogenous reconstruction is a well-accepted alternative treatment for prosthetic infection after reconstructive arterial surgery. Because of its technical complexity and the lack of suitable substitutes, the procedure remains limited to a few selected centers. We describe four patients with prosthetic infection after reconstructive surgery for lower limb ischemia. Treatment consisted of prosthetic excision and aortofemoral grafting with the use of the superficial femoral vein. All patients survived the operation and infection was eradicated in all cases. We conclude that the superficial femoral vein represents an acceptable arterial conduit in the treatment of these difficult cases.

Hemostasis obtained by manual compression after femoral artery catheterization results in consistently low rates of major complications. A rare complication of femoral artery catheterization is arterial infection. Its occurrence after diagnostic angiography using manual compression has not been reported. We report two cases of femoral arterial infection after uneventful diagnostic catheterization in nonimmunocompromised patients using the perclose percutaneous arterial closure device. Our cases are representative of perclose associated infections, with delayed presentation of a staphylococcal arterial infection requiring arterial debridement and reconstruction. This article indicates that perclose use carries a risk of severe arterial infection. Surgeons should be aware of the potential infectious complications associated with perclose use and the need for aggressive treatment. (J Vasc Surg 2001;34:983-5.)

Primary arterial infections continue to be one of the most challenging clinical problems encountered by vascular surgeons, and postoperative graft infection one of the most feared complications. As vascular infections present grave risks to life and limb, vascular surgeons must be fully informed concerning prevention, early diagnosis and prompt vigorous treatment. Much new information is available in recent years about arterial infection. New culture techniques have forced us to examine the prospect that a disturbingly high percentage of diseased arteries routinely harbor bacteria. Additionally, chronic intraaneurysmal thrombus is culture-positive in a

Vascular allografts have been used by surgeons with varying levels of enthusiasm over the last 100 years, to treat a wide variety of vascular conditions. This article reviews the history of vascular allografts, the current indications for use, and the background to current retrieval, processing and cryopreservation techniques.

To the Editor: The article by Gieffers et al1 in the January 23, 2001, issue of Circulation reiterates the general belief that lungs harbor Chlamydia pneumoniae organisms that are continuously released into the bloodstream. It is suggested that these organisms are carried by lung macrophages, which repeatedly infiltrate and infect atherosclerotic lesions. There are certain pathological features of human atherosclerotic lesions that suggest that this mechanism may not be entirely correct. Chlamydia pneumoniae usually causes mild upper respiratory tract infections. If the …

Percutaneous arterial closure devices allow earlier mobilization and discharge of patients after arterial catheterization than manual compression for achieving puncture site hemostasis. Our case is representative of Perclose associated infections; our patient had a delayed presentation of a staphylococcal arterial infection that required arterial debridement and reconstruction. Physicians should be aware of this uncommon, but serious complication to expedite the evaluation and treatment of patients with suspected infections that can arise from using these devices. (Korean Circulation J 2006;36:762-763)

Infection of a vascular prosthesis or an arterial receptor site is one of the most challenging situations for the vascular surgeon. In some instances the standard extraanatomic routes to bypass infected areas cannot be used. Two cases of arterial infection following renal transplantation are presented. An infrascrotal perineal approach for a femorofemoral bypass was used to achieve revascularization of a threatened limb.

Objectives: in patients with vascular prosthesis infection, to compare surgical outcome and long-term results of cryopreserved allograft implantations to conventional surgery. Design: retrospective study. Material and Methods: two asynchronous series of 44 [series I: 1980-1994; 8 patients with aortoenteric fistula (AEF)] and 22 (series II: 1994-1997; 4 patients with AEF) patients were treated for prosthesis infection. All patients had prosthesis excision. In series I, there were 4 in situ reparations, 26 extra-anatomic bypass, 13 excision only, and one death at laparotomy. In series II, in situ cryopreserved allografts were implanted in all patients. Results: operative mortality was 16% in series I and 13.6% in series II. For AEF patients, mortality was 37% in series I and 50% in series II. Among hospital survivors, infection-related late mortality was 13.5% in series I and 5% in series II. For AEF patients, late mortality was 20% in series I and 50% in series II. Incidence of reoperations was 54% in series I and 10.5% in series II (p < 0.01). Hospital stay was 47.2 ± 26.4 days in series I and 16.6 ± 11.5 days in series II (p < 0.001). Conclusions: compared to conventional treatment, incidence of reoperations and length of hospital stay are significantly decreased after cryopreserved allograft implantation. However, closure of aortic stump and extra-anatomic bypass gives better results for patients with AEF.Eur J Vasc Endovasc Surg 25, 416-423 (2003)

OBJECTIVE: Infection of synthetic grafts or femoral arteries in the groin is a challenging problem to treat. Femoro-popliteal vein (FPV) is an ideal conduit but extensive replacement of infected aortic grafts with FPV has been associated with significant morbidity. The aim of this study was to evaluate early and long-term outcome of limited replacement with FPV of infected femoral arteries/grafts in the groin.