Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin

Abstract

Hypothesis: Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. Design: A consecutive sample clinical study with a mean follow-up of 29 months. Setting: The surgical department of an academic tertiary care center and an affiliated secondary care center. Patients: Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. Main Outcome Measures: Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. Results: Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. Conclusion: Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin.

Medical treatment of prosthetic vascular graft infections: Review of the literature and proposals of a Working Group

“…Daptomycin has also demonstrated interesting capacities in biofilm penetration [65], and some studies revealed a higher activity against stationary phase staphylococci than vancomycin [66]. However, the clinical relevance of all these in vitro data is still lacking and the therapeutic choice of the antimicrobial chemotherapy to use to treat Page 9 of 64 A c c e p t e d M a n u s c r i p t 9 PVGIs cannot be only based on such biofilm penetration criteria, highlighting that clinical studies and data are required.…”

“…For other obligate anaerobes such as B. fragilis, the possibility of suppressive treatment should be evaluated after multidisciplinary consultation (C-III). weeks post-operatively [5,7,9,[11][12][13][14]25,27,28,35,37] without the risk of relapse appearing greater than that encountered when the treatment period is longer. This 6-…”

Pontage fémoro-fémoral croisé avec tunnulisation périnéale sous-scrotale pour une infection grave du triangle de scarpa

“…Johnson a rapporté un cas de pontage perméable après 7 ans de suivi [ 12 ]. Une seule étude dans la littérature s'est intéressée à la perméabilité de ce type de pontage, celle d'Illuminati et al colligeant 19 patients, avec une perméabilité primaire de 86% à 3 ans et un taux de sauvetage du membre de 91% [ 13 ]. Cette publication [ 13 ] est d'ailleurs la dernière dans la littérature se rapportant à cette technique de revascularisation.…”

Crossover ilio-iliac bypass and removal of femoro-femoral graft as first treatment for the infection of crossover bypass in aortouniiliac endovascular aneurysm repair

“…In addition to an operative mortality rate of an average of 5% and a recurrence rate of sepsis between 7 and 12%, the percentage of limb amputation after a thrombosis occurs, is also significant in the short or medium term from the graft implantation (between 10 and 20% at 5 years). 12…”