Creation of a neo-aortoiliac system from lower extremity deep and superficial veins

G. Patrick Clagett, Benjamin L. Bowers, Miguel A. Lopez-Viego, Matthew B. Rossi, R. James Valentine, Stuart I. Myers, Arun Chervu

Research output: Contribution to journalArticle

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Abstract

Objective This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. Summary Background Data The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. Methods A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prostheses (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. Results The in-hospital mortality and amputation rates were 10% each. The mean (± standard deviation [SD]) operative time was 6.5 ± 1.8 hours and the blood transfusion requirement was 4 ± 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 ± 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. Conclusion NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.

Original languageEnglish (US)
Pages (from-to)239-248
Number of pages10
JournalAnnals of Surgery
Volume218
Issue number3
StatePublished - Sep 1993

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Lower Extremity
Veins
Saphenous Vein
Amputation
Prostheses and Implants
Mortality
Extremities
Infection
Operative Time
Hospital Mortality
Thigh
Peritonitis
Blood Transfusion
Hyperplasia
Edema
Sepsis
Pathologic Constriction
Thrombosis
Hypertension
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Clagett, G. P., Bowers, B. L., Lopez-Viego, M. A., Rossi, M. B., Valentine, R. J., Myers, S. I., & Chervu, A. (1993). Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Annals of Surgery, 218(3), 239-248.

Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. / Clagett, G. Patrick; Bowers, Benjamin L.; Lopez-Viego, Miguel A.; Rossi, Matthew B.; Valentine, R. James; Myers, Stuart I.; Chervu, Arun.

In: Annals of Surgery, Vol. 218, No. 3, 09.1993, p. 239-248.

Research output: Contribution to journalArticle

Clagett, GP, Bowers, BL, Lopez-Viego, MA, Rossi, MB, Valentine, RJ, Myers, SI & Chervu, A 1993, 'Creation of a neo-aortoiliac system from lower extremity deep and superficial veins', Annals of Surgery, vol. 218, no. 3, pp. 239-248.
Clagett GP, Bowers BL, Lopez-Viego MA, Rossi MB, Valentine RJ, Myers SI et al. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Annals of Surgery. 1993 Sep;218(3):239-248.
Clagett, G. Patrick ; Bowers, Benjamin L. ; Lopez-Viego, Miguel A. ; Rossi, Matthew B. ; Valentine, R. James ; Myers, Stuart I. ; Chervu, Arun. / Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. In: Annals of Surgery. 1993 ; Vol. 218, No. 3. pp. 239-248.
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abstract = "Objective This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. Summary Background Data The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20{\%}, with an amputation rate of 10{\%} to 14{\%}. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. Methods A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prostheses (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. Results The in-hospital mortality and amputation rates were 10{\%} each. The mean (± standard deviation [SD]) operative time was 6.5 ± 1.8 hours and the blood transfusion requirement was 4 ± 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 ± 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64{\%}, compared to 0{\%} for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. Conclusion NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.",
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AU - Clagett, G. Patrick

AU - Bowers, Benjamin L.

AU - Lopez-Viego, Miguel A.

AU - Rossi, Matthew B.

AU - Valentine, R. James

AU - Myers, Stuart I.

AU - Chervu, Arun

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N2 - Objective This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. Summary Background Data The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. Methods A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prostheses (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. Results The in-hospital mortality and amputation rates were 10% each. The mean (± standard deviation [SD]) operative time was 6.5 ± 1.8 hours and the blood transfusion requirement was 4 ± 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 ± 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. Conclusion NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.

AB - Objective This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. Summary Background Data The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. Methods A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prostheses (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. Results The in-hospital mortality and amputation rates were 10% each. The mean (± standard deviation [SD]) operative time was 6.5 ± 1.8 hours and the blood transfusion requirement was 4 ± 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 ± 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. Conclusion NAIS reconstruction from lower extremity veins is a successful option in patients with extensive aortic prosthetic infection and other complex aortic problems.

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