Graft excision and extra-anatomic revascularization: the treatment of choice for the septic aortic prosthesis. J Cardiovasc Surg (Torino) 1990;31(3):327-32
Date
05/01/1990Pubmed ID
2370266Scopus ID
2-s2.0-0025036570 (requires institutional sign-in at Scopus site) 66 CitationsAbstract
Graft excision and extra-anatomic revascularization is the treatment of choice for the septic aortic prosthesis. From 1979 to 1988, 20 patients underwent resection of aortic grafts and extra-anatomic bypass for the treatment of graft infections (No. 11) and aorto-enteric fistulas (No.9). The mean time interval from primary aortic surgery to the reoperative procedure was 65 months (range 1-192 months). Three patients died (one less than 30 days) after the secondary procedure for a mortality rate of 15%. One patient developed infection of the extra-anatomic bypass graft which resulted in an above-knee amputation. This was the only major limb loss in this series. A second patient developed contralateral buttock necrosis when he had unilateral axillary-femoral bypass without femoral-femoral bypass because of a previous above-knee amputation on the affected side. Major complications occurred in 7 patients (35%). Mean duration of follow-up after the reoperative aortic procedure was 44 months (range 6-120 months). One patient suffered aortic stump blowout 7 months after repair of an aortic duodenal fistula. Aortic graft excision and extra-anatomic revascularization of the lower extremities can be performed with low mortality and risk of limb loss and should remain the treatment of choice for aorto-enteric fistulas and infected aortic prostheses. Bilateral groin revascularization is important even in patients who have had a previous lower extremity amputation to provide pelvic blood flow.
Author List
Schmitt DD, Seabrook GR, Bandyk DF, Towne JBMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Anastomosis, Surgical
Aorta
Aortic Diseases
Bacterial Infections
Blood Vessel Prosthesis
Female
Femoral Artery
Humans
Intestinal Fistula
Male
Middle Aged
Postoperative Complications
Prosthesis Failure
Reoperation
Retrospective Studies
Time Factors
