Midterm Results of Replacement of Synthetic Graft and Arterial Infection in the Groin With Femoropopliteal Vein

Abstract

Infection of synthetic grafts or femoral arteries in the groin is a challenging problem to treat. Femoropopliteal 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. Data from 37 patients who underwent excision of infected femoral grafts and replacement with FPV over an 18-year period from 1994 to 2012 were retrospectively analyzed. Surgical intervention was performed in 41 limbs of 27 men and 10 women (mean age, 67.5 years) at a median of 2.5 years after the original synthetic implantation (aortofemoral n = 21, femorofemoral n = 3, femorodistal n = 5, patch angioplasty n = 2) or, on average, 22.2 days after cardiac catheterization (n = 6) and one mycotic aneurysm. Presentation included draining sinus (n = 7), abscess (n = 4), persistent fevers (n = 6), and pseudoaneurysm (n = 10; intact, 4; ruptured, 6). Twenty-five patients (61%) underwent muscle flap cover of the FPV reconstruction. In-hospital/30-day mortality was 5.4% (2 of 37); one from respiratory failure 20 days postoperatively, and the second, a 93-year-old woman, after withdrawal of care at 24 hours. No patients required fasciotomy, and five wound hematomas required reoperation. Focal femoropopliteal vein thrombosis occurred in five limbs. Over a mean follow-up of 2.5 years (range, 0.03-13.3) 11 patients died of unrelated causes at a mean of 3.7 years (range, 0.2-10.6 years). Graft reintervention was required in seven patients during follow-up for graft thromboses (n = 2) stenoses (n = 2), and anastomotic false aneurysms (n = 3). Apart from the latter, there was no other suggestion of graft reinfection in any patient. Major limb loss occurred in one patient at 6 months despite a patent graft. Long-term FPV harvest morbidity included mild leg swelling in 10 patients. Replacement of infected synthetic grafts/femoral arteries in the groin with FPV is safe and results in excellent limb preservation and freedom from reinfection. FPV should be considered the preferred conduit in good-risk patients with infection limited to the groin.