Deep Femoral Vein Reconstruction of the Abdominal Aorta and Adaptation of the Neo-Aortoiliac System Bypass Technique in an Endovascular Era

Nordanstig, Joakim; Törngren, Kristina; Smidfelt, Kristian; Roos, Håkan; Langenskiöld, Marcus

doi:10.1177/1538574418801100

Cited by 21 publications

(20 citation statements)

References 26 publications

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“…Two main approaches to clamp the aorta were used. In seven patients with an endograft and in two patients with a conventional aortic graft, aortic balloon occlusion via the left axillary artery was used, 13 whereas the remaining 31 patients had standard aortic clamping. Eight patients requiring suprarenal clamping also underwent left renal vein division without re-attachment.…”

Section: Peri-operative Detailsmentioning

confidence: 99%

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Langenskiöld

Persson

Daryapeyma

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis paper describes the experience of in situ reconstruction of aortic graft and endograft infections using autologous deep femoral vein and reports overall favourable patient outcomes from the procedure. In particular, the explantation of infected aortic endografts was not associated with increased mortality and morbidity, and freedom for antibiotic therapy after one year was high, indicating a high curative treatment rate. Post-operative renal damage was limited, even in patients in need of suprarenal clamping and permanent renal vein division. Autologous vein graft reconstruction of aortic graft and endograft infections represents a method of choice in these challenging patients.Objective: Aortic prosthesis infection is a devastating complication of aortic surgery. In situ reconstruction with the neo-aorto-iliac system (NAIS) bypass technique has become increasingly used and is recommended in recent treatment guidelines. The main aim was to evaluate NAIS procedural outcomes when undertaken after previous open or endovascular aortic repair in Sweden. Methods: In this retrospective study, The National Quality Registry for Vascular Surgery (Swedvasc) was used to identify Swedish centres that offered the NAIS bypass procedure for aortic prosthesis infection between 2008 and 2018. Variables of special interest were procedural details, short and long term survival, renal and other complications, and the durtion of antimicrobial treatment. Results: Forty patients (36 males, four females [mean age 69 years], 32 open repairs, seven endovascular aortic repairs [EVAR] and one fenestrated EVAR; 21 presented with aorto-enteric fistula) operated on with NAIS bypass were reviewed. The median time from the primary aortic intervention to the NAIS bypass procedure was 32 months (range 0 e 252 months). Mean AE standard deviation operating time was 645 AE 160 minutes, mean blood loss was 6 277 AE 6 525 mL, mean length of intensive care unit stay was 5.3 AE 3.7 days, and mean length of overall hospital stay was 21.2 AE 11.4 days. Thirty-five patients (88%) had a positive microbial culture; the most commonly isolated pathogen was Candida spp. The majority of patients survived for 30 days (n ¼ 35 [88%]), and 33 (83%) and 32 (80%) patients survived for 90 days and one year, respectively. The number of surviving patients free from antimicrobial treatment at 90 days, six months, and one year was 19 (58%), 29 (88%), and 30 (94%). After a mean long term follow up of 69.9 AE 44.7 months, 20 patients were still alive. Conclusion:The NAIS bypass procedure offered reasonable survival and functional outcomes, and was associated with a high cure rate, defined as freedom from any antimicrobial treatment.

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Section: Peri-operative Detailsmentioning

confidence: 99%

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Langenskiöld

Persson

Daryapeyma

et al. 2021

European Journal of Vascular and Endovascular Surgery

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“… 6 Failure of the aortic anastomosis has been described. 5 , 7 In this particular case, the reason for proximal graft failure is unclear. At the time of the primary procedure, there was recognition of aortic arteriosclerosis but it was not felt that this finding would prejudice the proximal anastomosis.…”

Section: Discussionmentioning

confidence: 87%

“…Aortoiliac reconstruction using autologous deep femoral vein is a therapeutic option for management of prosthetic aortic graft infection and has advantages over both aortic ligation with extra-anatomic bypass or replacement with a rifampicin-bonded prosthesis. Potential benefits include a decrease in the risk of stump blow-out from aortic ligation 5 and a decrease in recurrent infection by avoiding replacement with prosthetic material. Importantly, there seems to be a decrease in perioperative mortality 4 with improved long-term patency when compared with extra-anatomic bypass.…”

Section: Discussionmentioning

confidence: 99%

Endovascular salvage of an aortic anastomotic pseudoaneurysm following deep vein reconstruction

Hamilton

Hennessy

Hussey

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Aortoiliac reconstruction using autologous deep femoral vein (neoaortic iliac system bypass [NAIS]) is a therapeutic option for management of prosthetic aortic graft infection. Complications after NAIS are complex and reported management strategies few. Endovascular procedures offer a minimally invasive alternative to high-risk, complex open surgery. We report a case of early aortic anastomotic failure after NAIS associated with a pseudoaneurysm and significant retroperitoneal hemorrhage, which was successfully treated by endovascular stent grafting.

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“…Three of the four patients with graft infection following treatment with a primarily open abdomen at SUH died within 90 days. One was treated conservatively with antibiotics during 18 months and then developed an aortoduodenal fistula and underwent a subacute resection of the graft and reconstruction of the aorta using a femoral vein as described by Nordanstig et al, 18 after which the recovery was uneventful. Two of the three patients with graft infection in the control group died within 90 days and one was treated conservatively with chronic antibiotic therapy and died 32 months after the aortic repair for unknown reasons.…”

Section: Resultsmentioning

confidence: 99%

Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score–matched study

et al. 2019

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Objective: To investigate whether a strategy of treatment with a primarily open abdomen improves outcome in terms of mortality and major complications in patients treated with open repair for a ruptured abdominal aortic aneurysm compared to a strategy of primary closure of the abdomen. Design: Retrospective cohort study. Methods: Patients treated with a primarily open abdomen at a centre where this strategy was routine in most ruptured abdominal aortic aneurysm patients were compared to a propensity score–matched control group of patients who had the abdomen closed at the end of the primary operation in a majority of the cases. Results: In total, 79 patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm at Sahlgrenska University Hospital were compared to a propensity score–matched control group of 148 patients. The abdomen was closed at the end of the procedure in 108 (73%) of the control patients. There was no difference in 30-day mortality between patients treated with a primarily open abdomen at Sahlgrenska University Hospital and the controls, 21 (26.6%) versus 49 (33.1%), p = 0.37. The adjusted odds ratio for mortality at 30 days was 0.66 (95% confidence interval: 0.35–1.25) in patients treated with a primarily open abdomen at Sahlgrenska University Hospital compared to the controls. No difference was observed between the groups regarding 90-day mortality, postoperative renal failure requiring renal replacement therapy, postoperative intestinal ischaemia necessitating bowel resection or postoperative bleeding requiring reoperation. Conclusions: The study did not show any survival advantage or difference in major complications between patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm and propensity-matched controls where the abdomen was primarily closed in a majority of the cases.

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Deep Femoral Vein Reconstruction of the Abdominal Aorta and Adaptation of the Neo-Aortoiliac System Bypass Technique in an Endovascular Era

Cited by 21 publications

References 26 publications

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Endovascular salvage of an aortic anastomotic pseudoaneurysm following deep vein reconstruction

Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score–matched study

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