Autogenous tissue reconstruction in the management of aortoiliofemoral graft infection

Management of infected prosthetic arterial grafts remains a challenging clinical problem. Revascularization following removal of the infected arterial prosthesis is frequently necessary and usually achieved using remote extraanatomic bypasses. We present three cases where complete removal of the infected prosthesis was followed by autogenous reconstruction using reversed saphenous vein, endarterectomized segments of superficial femoral artery, or endarterectomy of the native occluded vessels. Eradication of the infection was seen in all three patients. The reconstructions have remained patent in the three patients with follow-up from four months to three years. Percutaneous balloon dilation was successful in the management of a distal limb stenosis in one patients. Autogenous vascular reconstruction following removal of infected prosthetic vascular grafts remains a viable alternative in the treatment of difficult, selected cases of infected arterial prosthesis. It is probably an underutilized alternative, when one considers that the surgical techniques employed are familiar to vascular surgeons. Cure of the infection and prepreservation of critical vascular beds can both be achieved with autogenous tissue, either in situ or from remote areas. Available percutaneous techniques may play an important role in maintaining durability of these reconstructions.Presented at the Annual Meeting of the Peripheral Vascular Surgery Society, New York, New York, June 17, 1989.