Peripheral Vascular Surgery Society

Philip M. Brown, Jr., MD, Victor B. Kim, MD,

William M. Bogey, MD, and C. Steven Powell, MD.

East Carolina University, Greenville, NC

Purpose: Autogenous reconstruction is one option available for patients with aortic graft infection or mycotic aneurysms. We reviewed our recent institutional experience with all patients undergoing aortic reconstruction using autologous superficial femoral vein (SFV).

Methods: From February 1995 to November 1997, 8 patients (5 with prosthetic aortic graft infections and 3 with mycotic aneurysms, including one ruptured mycotic AAA) underwent one stage aortic reconstruction using autologous SFV. Therapy for graft infection included graft excision and replacement with aortobifemoral or aortofemoral (with subsequent cross femoral) grafts fashioned from SFV. The two patients undergoing elective repair of mycotic aneurysms were treated with extensive SFV patches, and the patient with a ruptured mycotic aneurysm underwent SFV tube grafting.

Results: There were no deaths within the first 30 days, but one patient died from mesenteric infarction on postoperative day 38 after infrarenal aortic replacement for an overall mortality rate of 12.5%. There were no early or late amputations. Postoperative morbidity included one abdominal wound dehiscence, one case of acalculous cholecystitis, one case of acute tubular necrosis requiring temporary dialysis, and leg swelling requiring only conservative management. All grafts are patent and there has been no late mortality to date.

Conclusion: Autogenous reconstruction of the aorta using SFV in infected fields shows promise for salvage of life and limb during early experiences and short term follow-up. Morbidity and mortality rates compare favorably with existing series, reconstruction is anatomic, and reinfection potential is low. Long term follow-up and more extensive experience with this technique are needed to establish its role relative to other conventional methods.