Utilization of Autologous Superficial Femoral Vein Graft in Cases of Infected Prosthetic Graft Replacement and High Infection-risk Cases

Abstract

Introduction: Aortic prosthetic graft infection is one of the most severe complications in vascular surgery. There are two common scenarios - infection of already implanted graft and the prevention of graft infection in high-risk cases. In literature are reported good results of infected graft removal and reconstruction of aorto or iliac/femoral segment with autologous superficial femoral vein (SFV) graft. Main goal of our study was to evaluate efficiency and safety of this method for treatment of patients with aortic graft infection and in cases of patients with high prosthetic graft infection (e.g. with ischemic wounds). Methods: Between June 2007 and June 2018 we used autologous SFV graft for aorto iliac/femoral reconstruction in 64 cases (51 male and 13 female, average age 64.0 years with range from 30 to 79 years). In 33 cases was SFV graft used for replacement of infected prosthetic graft (13 aortobifemoral, 9 aortofemoral, 1 aortoaortic, 1 axillobifemoral, 3 replacement of one arm of aortobifemoral graft, 6 iliofemoral, 1 cross-over iliofemoral graft) and in 1 case replacement of infected stentgraft. In 29 cases was SFV graft used as a primary reconstruction in situations of high risk of graft infection (mycotic aneurysms, foot gangrene with highly virulent microbial findings, high CRP, fever). Results: Average follow-up time of our patients was 46.6 ± 33.0 months (range 1 - 127 months). 30-day mortality in our patient population was 6.3 % (4 patients died at 8th, 16th, 21st and 21st postoperative day). During the follow-up period more 26 patients died, but none of them in relation to SFV graft implantation, which remained patent in the time of dead. In one case (equal to 1.6 %) early re-intervention was required because of the graft failure. We observed one graft occlusion at 5th month. 5 patients (equal to 7.8 %) required high lower limb amputation till 3 months after the reconstruction, reason was the progression of peripheral arterial occlusive disease. We didn't observe any case of pulmonary embolism, infection recurrence, serious edema after SFV harvesting neither aneurysmatic dilatation of venous graft. In four cases (equal to 6.3 %) we observed temporary limb edema after SFV harvesting, but this situation was well controlled by compression stocking therapy. There was complicated wound healing after vein harvesting observed in 5 cases (equal to 7.8 %) and seroma in wound was observed in 3 cases (equal to 4.7 %). Conclusion: Our results support the use of SFV graft both in treatment of prosthetic graft infection in abdominal aortic region and for elective reconstructions in cases of patients with high risk of prosthetic graft infection. Comparing effectiveness and safety of SFV graft reconstruction with other methods speaks in favor of SFV grafting. Risk of infection recurrence is minimal, long-term patency is excellent and fear of serious limb edema after SFV harvesting is unjustified. Disclosure: Nothing to disclose