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Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin
Giulio Illuminati, MD;
Francesco G. Caliò, MD;
Antonio D’Urso, MD;
Daniela Giacobbi, MD;
Vassilios Papaspyropoulos, MD;
Gianluca Ceccanei, MD
Arch Surg. 2004;139:1314-1319.
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.
Author Affiliations: "Francesco Durante" Department of Surgical Sciences and Applied Technologies, University of Rome "La Sapienza," Rome (Drs Illuminati, D’Urso, Giacobbi, Papaspyropoulos, and Ceccanei), and the Unit of Vascular Surgery, Sant’Anna Hospital, Catanzaro (Dr Caliò), Italy.
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