Surgical management of an infected external iliac artery interposition graft with a bioengineered human acellular vessel.

Christy Guth,Thomas Naslund

doi:10.1016/j.jvscit.2021.10.002

Christy Guth, Thomas Naslund

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https://doi.org/10.1016/j.jvscit.2021.10.002

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Infection of prosthetic vascular grafts can manifest as pain, pseudoaneurysms, or arterial insufficiency in the leg. We present the case of a female patient with a medical history of a right external iliac artery endofibrosis, with a persistently infected synthetic iliofemoral bypass graft, which we replaced with a bioengineered human acellular vessel. At the 12-month follow-up visit, the clinical and radiologic studies demonstrated adequate human acellular vessel patency, with no signs of infection, stenosis, or pseudoaneurysm. Subsequent to the initiation of hormone therapy and cessation of antiplatelet therapy, the patient developed graft thrombosis. She continued to do well after restoration of patency with lytic therapy. At 22 months, secondary patency has been maintained with continued anticoagulation therapy, and the patient has remained asymptomatic.

Highlights

Prosthetic vascular graft infections (PVGI) are a challenging complication with an incidence of0.5% to 6% after surgical bypass.[5]
-p ro which was subsequently replaced with human acellular vessel (HAV), in a US Food and Drug Administration (FDA)
There is increased risk of kinking due to repetitive hip flexion and it was felt best to avoid an anastomosis in an unaffected limb., use of the HAV was requested from and approved within 48 hours by the US FDA under an individual patient expanded access Investigational New Drug (IND) application (18891)

Summary

INTRODUCTION

Prosthetic vascular graft infections (PVGI) are a challenging complication with an incidence of. Extra-anatomic grafts can be used to bypass outside the infected field and have a reasonable patency of 80% at 5 years.[18] In an active cyclist, there is increased risk of kinking due to repetitive hip flexion and it was felt best to avoid an anastomosis in an unaffected limb., use of the HAV was requested from and approved within 48 hours by the US FDA under an individual patient expanded access Investigational New Drug (IND) application (18891). At 1-month, duplex ultrasound revealed a widely patent graft without evidence of perigraft fluid By this time, the patient was active and walking with minimal claudication, which was improved compared to preoperative assessments. The patient is managed with oral anticoagulation after recovery from hysterectomy and doing well 22 months post-op

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CONCLUSION