This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Use of superficial femoral/popliteal veins for suprainguinal arterial reconstruction in the presence of infection. BJS 2000; 87: 506-507.
Published: 6th December 2002
Authors: C. P. Gibbons, C. J. Ferguson, K. Edwards, H. Y. Osman
Background
Mycotic aneurysms and graft infection in the aortoiliac region provide formidable technical challenges and carry a high morbidity and mortality rate with either of the standard techniques of in situ antibiotic‐bonded prosthetic reconstruction or extra‐anatomical bypass. This study investigated the use of autologous superficial femoral/popliteal vein (SFPV) for arterial reconstruction in ten patients with arterial or graft infections of the aortoiliac region.
Method
Two patients with mycotic aortic aneurysms and four with aortic graft infections underwent aortoiliac replacement with SFPV after thorough debridement and/or excision of infected graft material. Three infected femorofemoral grafts were replaced in situ with reversed SFPV and an infected axillofemoral graft was converted to an iliofemoral reversed SFPV graft. All patients received appropriate antibiotic therapy and were followed by regular postoperative duplex imaging. Preoperative femoral vein duplex imaging was performed in eight of ten patients to confirm suitability as a graft.
Results
Nine of the ten patients survived with a functioning graft and without limb loss or evidence of infection at 3–30 months. One patient died from myocardial infarction after operation. Two patients had minor swelling of one leg. Three patients required angioplasty of anastomotic stenoses detected by duplex surveillance at 6 weeks.
Conclusion
SFPV is an excellent conduit for aortic or iliac reconstruction in the presence of infection. Duplex imaging is useful to confirm the suitability of deep veins for use as a graft and for postoperative surveillance. © 2000 British Journal of Surgery Society Ltd
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