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The Role of Autogenous Superficial Femoropopliteal Vein Reconstruction

Lori L. Gordon, MD; Ryan T. Hagino, MD; Mark R. Jackson, MD; J. Gregory Modrall, MD; R. James Valentine, MD; G. Patrick Clagett, MD

Arch Surg. 1999;134:615-621.

Background  With increasing experience, we have encountered patients with complex aortofemoral prosthetic infections in whom extra-anatomic bypass (EAB) is not an option.

Hypothesis  Autogenous superficial femoropopliteal vein (SFPV) aortic reconstruction provides a limb-saving and lifesaving alternative with acceptable morbidity and mortality.

Design  Retrospective review.

Setting  University-based county, private, and Veterans Affairs hospitals.

Patients  Seventeen patients with infected aortofemoral bypasses in whom conventional EAB was impossible because of infection of previously placed EAB, massive groin and/or thigh sepsis, or both.

Main Outcome Measures  Morbidity and mortality.

Results  Multiple previous operations were common (mean, 4 per patient) and included EAB (n=11), replacement aortofemoral bypass (n=4), prosthetic femoropopliteal bypass (n=7), and thoracobifemoral bypass (n=1); all bypasses became infected. Overall, 11 patients had sepsis at the time of presentation. Of the patients with massive groin infection, 7 had extensive deep infections involving most of the proximal thighs or retroperitoneum, 4 had enterocutaneous fistulae, and 2 had necrotizing fasciitis of the lower abdomen and thigh. Polymicrobial infections were common (n=9). Four patients (24%) died in the perioperative period, 8 (47%) suffered major complications, and 4 (24%) underwent major amputations. Mortality in this group of patients was 3 times that of all other patients undergoing autogenous SFPV aortic reconstruction for prosthetic infection (8%). Amputation rates were also increased (24% vs 6%). The mean ± SD follow-up time is 23 ± 21 months. All patients maintained patent SFPV reconstructions.

Conclusions  In the setting of complex aortofemoral prosthetic infections, autogenous SFPV aortic reconstruction is a useful option for patients in whom EAB is impossible and limb loss and/or death would be inevitable without revascularization.

From the Division of Vascular Surgery, University of Texas Southwestern Medical Center, Dallas (Drs Gordon, Jackson, Modrall, Valentine, and Clagett), and the Vascular Surgery Section, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex (Dr Hagino).

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