Staging the neoaortoiliac system: Feasibility and short-term outcomes

Abstract

The NAIS can be staged without compromising the efficacy of the procedure as evident by excellent long-term patency and control of the infection. By reducing the duration of the primary procedure, staging may be beneficial to both the patient and the surgeon.

Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts

“…Ali et al recently reported shortening the NAIS operation by staging FPV harvest. 21 The femoral veins are dissected and left in situ and the aortic graft excision and NAIS reconstruction are carried out 24 hours later.…”

“…20 The only other significant technical modification has been staging the operation in a minority of cases in this series (n ϭ 5). This approach entailed dissection of the FPVs at one setting, followed by vein graft harvest, excision of the infected graft, and NAIS reconstruction one day later, as described by Ali et al 21 In the postoperative period, patients were routinely treated with subcutaneous low dose heparin and calf intermittent pneumatic compression for venous thromboembolism prophylaxis.…”

Abdominal Aortic Graft Infection

“…This is specifically related to the technical challenge posed when attempting to avoid infection in the femoral region and simultaneously construct a durable prosthetic extra-anatomic bypass. On the other hand, the autogenous femoral vein graft is resistant to infection and appears to have a 2-year patency rate that exceeds 90% (Ali et al, 2008).…”

“…It is termed staged NAIS and refers to any aortoiliofemoral reconstruction using deep femoral popliteal veins in the treatment of aortic graft infections that is not completed in a single operation (Ali et al, 2008). At the initial operation, the deep veins are exposed, the side branches are divided and suture-ligated, and the incisions temporarily closed over closed-suction drains.…”

“…Especially in the presence of limbthreatening ischemia in conjunction with aortic graft infection, the advocates of the staged version, argue that deep femoral popiliteal vein mobilization may cause disruption of collaterals and precipitate acute ischemia. In such cases, the authors recommend that aortofemoral bypass be performed in the ischemic limb first, followed by femorofemoral bypass to the contralateral limb within 4 to 18 days later (Ali et al, 2008). The advantages of autogenous femoroepopliteal vein replacement (NAIS) can be summarized as follows: a) superior long-term patency, limb salvage, b) minimal chance or reinfection, c) no aortic stump in the context of infected field, d) long-term antibiotic/antithrombotic therapy unnecessary (Lopera et al, 2008).…”