1. Editor's Choice – Treatment of Aortic Prosthesis Infections by Graft Removal and In Situ Replacement with Autologous Femoral Veins and Fascial Strengthening
- Author
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M. Jaroma, Pekka Aho, Ivika Heinola, Pirkka Vikatmaa, Maarit Venermo, Ilkka Kantonen, Anders Albäck, Verisuonikirurgian yksikkö, and Clinicum
- Subjects
Male ,Time Factors ,SURGERY ,medicine.medical_treatment ,Femoral vein ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Fasciotomy ,0302 clinical medicine ,POPLITEAL VEIN ,Recurrence ,Risk Factors ,030212 general & internal medicine ,Aorta ,Finland ,Aged, 80 and over ,AUTOGENOUS RECONSTRUCTION ,Medicine(all) ,Graft Occlusion, Vascular ,Middle Aged ,Prosthesis Failure ,3. Good health ,Treatment Outcome ,Female ,AORTOENTERIC FISTULA ,Cardiology and Cardiovascular Medicine ,Infection ,Reoperation ,medicine.medical_specialty ,Prosthesis-Related Infections ,UNITED-STATES ,Anastomosis ,Revascularization ,Transplantation, Autologous ,Amputation, Surgical ,Disease-Free Survival ,CRYOPRESERVED ARTERIAL ALLOGRAFTS ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Blood vessel prosthesis ,Popliteal vein ,medicine ,MANAGEMENT ,Humans ,Aortic graft ,REINFECTION ,Device Removal ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,LOWER-EXTREMITY DEEP ,Vascular surgery ,3126 Surgery, anesthesiology, intensive care, radiology ,Graft rupture ,Blood Vessel Prosthesis ,Surgery ,Amputation ,EXPERIENCE ,business - Abstract
Introduction: Aortic prosthetic graft infection (AGI) is a major challenge in vascular surgery. Eradicating the. infection requires prosthetic material removal, debridement, and lower limb revascularization. For the past 15 years, we have used femoral veins for aorto-iliac reconstruction and tensor fascia lata to strengthen the upper anastomosis. Objective: The purpose of this single institution retrospective study is to present results regarding in situ replacement of infected aortic grafts with autologous femoral veins (FVs). Methods: From October 2000 to March 2013, patients treated for AGI with graft removal and autologous FV reconstruction at Helsinki University Hospital were included. Primary outcome measures were 30 day mortality, long-term treatment related mortality, and re-infection rate. Secondary outcome measures were long-term all cause mortality and event free survival (graft rupture, re-intervention, major amputation). Results: During a 13 year period 55 patients (42 male, 13 female) were operated on using a venous neo-aorto-iliac system for AGI. The mean follow up was 32 months (1-157 months). The 30 day mortality rate was 9% (5) and overall treatment related mortality 18% (10). All cause mortality during follow up was 22 (40%) and overall Kaplan-Meier survival was 90.7% at 30 days, 81.5% at 1 year, and 59.3% at 5 years. Graft rupture occurred in three (5%) cases, two of which were caused by graft re-infection. (4%). Four patients required major amputation, one of them on arrival and three (5%) during the post-operative period. Nine (16%) patients needed interventions for the vein graft, and two graft limbs occluded during follow up. Conclusion: In situ reconstruction for aortic graft infection with autologous FV presents acceptable rates of morbidity and mortality, and remains the treatment of choice for AGI at Helsinki University Hospital. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
- Published
- 2016
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