Bypass grafting in patients with infected vascular grafts

Shlomin V.V.^1,2, Puzdryak P.D.^1,3, Cheplygin V.S.⁴, Bondarenko P.B.⁴, Yurtaev E.A.¹, Gorbunov G.N.², Didenko Yu.P.^1,2, Drozhzhin I.G.¹, Dmitrievskaya N.O.¹, Tigrov I.V.³

1) Department of Vascular Surgery, Municipal Multimodality Hospital №2,
2) Department of Cardiovascular Surgery,
3) Department of General Surgery, North-Western State Medical University named after I.M. Mechnikov,
4) National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia

Analysed herein are the results of treating a total of 17 patients presenting with pathology of the aorta and lower-limb arteries, who from 2010 to 2018 required redo interventions due to infection of a previously implanted synthetic vascular graft. At admission, 3 patients were diagnosed as having an open infected wound, 11 were found to have a fistula, 2 had a false aneurysm in the area of the distal anastomosis of the branch of the bifurcation aortofemoral prosthesis, and 1 had thrombosis of the branch of the prosthesis with evidence of infection. As redo surgery, 4 patients underwent subclavian-femoral bypass grafting, 2 were subjected to crossover iliac-femoral bypass grafting, 8 to unilateral iliac-femoral bypass grafting, 3 to loop endarterectomy. In the majority of cases (14 of the 17) we used bypass grafting with creation of the tunnel through the muscular lacuna.

Lethal outcomes were registered in 35% (n=6) of cases in the early postoperative period. Death was caused by acute renal failure in 6% (n=1), by acute mesenteric thrombosis in 12% (n=2), by gastrointestinal haemorrhage in 6% (n=1), and by multiple organ failure in 12% (n=2).

Long-term mortality amounted to 33% (n=3) within 12 months. The main causes of death were increasing renal failure in 10% (n=1) and cardiovascular insufficiency on the background of heart diseases in 10% (n=1), as well as respiratory insufficiency in 10% (n=1). Reinfection in the remote period was diagnosed in 1 patient.

A conclusion was drawn that bypass grafting is traumatic, however, it may be the only way to save the limb or patient’s life in a complicated clinical situation. Using the superficial femoral vein as a shunt demonstrated good long-term results as to patency and resistance to surgical infection. Using a flap of the greater omentum, retroperitoneal fat, as well as wrapping of the prosthesis with a muscular flap ensured good tolerance of the zone of bypass grafting to reinfection.

KEY WORDS: aortofemoral bifurcation prosthetic repair, infection of a synthetic vascular graft, bypass grafting, extra-anatomical bypass grafting.

P. 156

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