Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis

• Published in: Journal of vascular surgery Vol. 59; no. 3; pp. 675 - 683
• Main Authors: Dorweiler, Bernhard, MD, PhD, Neufang, Achim, MD, PhD, Chaban, Rayan, MD, Reinstadler, Jan, MD, Duenschede, Friedrich, MD, PhD, Vahl, Christian-Friedrich, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.03.2014
• Subjects: Aged; Aged, 80 and over; Aneurysm, Infected - diagnosis; Aneurysm, Infected - microbiology; Aneurysm, Infected - mortality; Aneurysm, Infected - surgery; Aortic Aneurysm - diagnosis; Aortic Aneurysm - microbiology; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortography - methods; Autografts; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Female; Femoral Artery - diagnostic imaging; Femoral Artery - microbiology; Femoral Artery - physiopathology; Femoral Artery - surgery; Femoral Vein - physiopathology; Femoral Vein - transplantation; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Humans; Iliac Aneurysm - diagnosis; Iliac Aneurysm - microbiology; Iliac Aneurysm - mortality; Iliac Aneurysm - surgery; Kaplan-Meier Estimate; Limb Salvage; Male; Middle Aged; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - mortality; Prosthesis-Related Infections - surgery; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Reconstructive Surgical Procedures - mortality; Recurrence; Reoperation; Retrospective Studies; Risk Factors; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Patency; Venous Thrombosis - etiology; Venous Thrombosis - physiopathology
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.09.029

Objective To analyze early and late mortality, venous morbidity, reinfection, and freedom from reintervention after using the femoral vein (FV) for vascular reconstruction with infection of the aortoiliofemoral axis. Methods By reviewing our database, 86 patients could be identified with implantation of FV grafts in infected fields between November 1995 and July 2012. The patient records were retrospectively analyzed and follow-up information obtained from patients or their general physician. Seventy-one patients presented with prosthetic graft infection and 15 with an infected aneurysm. For data analysis, patients were divided into an aortoiliac (n = 67) and a femoral group (n = 19). Study end points assessed were early and late mortality, incidence of deep vein thrombosis of the FV donor limb, graft patency, limb salvage, reinfection, and freedom from reintervention. Results Sixty-seven aortoiliac reconstructions were performed using 84 FV grafts with an operative mortality of 9%. After a mean follow-up of 45 months, survival, patency, limb salvage, and freedom from reintervention were 45%, 97%, 94%, and 91%, respectively, at 5 years. Twenty FV grafts were employed for 19 femoral reconstructions with an operative mortality of 10.5%. Here, mean follow-up was 35 months and survival, patency, limb salvage, and freedom from reintervention were 29%, 87%, 93%, and 81%, respectively, at 5 years. Specimen culture confirmed Staphylococcus ( epidermidis and aureus ) as the predominant microorganism. Venous morbidity after FV harvest showed an incidence of deep venous thrombosis of 13.7% for popliteal and 10.6% for tibial level at a follow-up of 24 months with only mild clinical symptoms (21% limb swelling). Conclusions Vascular reconstruction using autologous FV in arterial and graft infection of the aortoiliofemoral axis provides durable long-term results with acceptable mortality and morbidity.